Method of applying staples to liver and other organs

ABSTRACT

A method for treating a patient includes a surgical instrument having a handle assembly, a shaft assembly, and an end effector. The end effector includes an upper jaw and a lower jaw configured to pivot to receive a tissue of the patient therebetween. The upper and lower jaws respectively have upper and lower crush surfaces, which extends generally parallel with a centerline and are configured to receive the tissue thereagainst. The upper jaw also includes an anvil, whereas the lower jaw includes a staple cartridge and a deck facing the anvil. In addition, the lower jaw has a plurality of staple opening formed through the deck with a plurality of staples received therein. The upper and lower crush surfaces are configured to compress the tissue therebetween with a crush pressure configured to sever the tissue along the upper and lower crush surfaces.

BACKGROUND

In some settings, endoscopic surgical instruments may be preferred overtraditional open surgical devices since a smaller incision may reducethe post-operative recovery time and complications. Consequently, someendoscopic surgical instruments may be suitable for placement of adistal end effector at a desired surgical site through the cannula of atrocar. These distal end effectors may engage tissue in a number of waysto achieve a diagnostic or therapeutic effect (e.g., endocutter,grasper, cutter, stapler, clip applier, access device, drug/gene therapydelivery device, and energy delivery device using ultrasonic vibration,RF, laser, etc.). Endoscopic surgical instruments may include a shaftbetween the end effector and a handle portion, which is manipulated bythe clinician. Such a shaft may enable insertion to a desired depth androtation about the longitudinal axis of the shaft, thereby facilitatingpositioning of the end effector within the patient. Positioning of anend effector may be further facilitated through inclusion of one or morearticulation joints or features, enabling the end effector to beselectively articulated or otherwise deflected relative to thelongitudinal axis of the shaft.

Examples of endoscopic surgical instruments include surgical staplers.Some such staplers are operable to clamp down on layers of tissue, cutthrough the clamped layers of tissue, and drive staples through thelayers of tissue to substantially seal the severed layers of tissuetogether near the severed ends of the tissue layers. Merely exemplarysurgical staplers are disclosed in U.S. Pat. No. 4,805,823, entitled“Pocket Configuration for Internal Organ Staplers,” issued Feb. 21,1989; U.S. Pat. No. 5,415,334, entitled “Surgical Stapler and StapleCartridge,” issued May 16, 1995; U.S. Pat. No. 5,465,895, entitled“Surgical Stapler Instrument,” issued Nov. 14, 1995; U.S. Pat. No.5,597,107, entitled “Surgical Stapler Instrument,” issued Jan. 28, 1997;U.S. Pat. No. 5,632,432, entitled “Surgical Instrument,” issued May 27,1997; U.S. Pat. No. 5,673,840, entitled “Surgical Instrument,” issuedOct. 7, 1997; U.S. Pat. No. 5,704,534, entitled “Articulation Assemblyfor Surgical Instruments,” issued Jan. 6, 1998; U.S. Pat. No. 5,814,055,entitled “Surgical Clamping Mechanism,” issued Sep. 29, 1998; U.S. Pat.No. 6,978,921, entitled “Surgical Stapling Instrument Incorporating anE-Beam Firing Mechanism,” issued Dec. 27, 2005; U.S. Pat. No. 7,000,818,entitled “Surgical Stapling Instrument Having Separate Distinct Closingand Firing Systems,” issued Feb. 21, 2006; U.S. Pat. No. 7,143,923,entitled “Surgical Stapling Instrument Having a Firing Lockout for anUnclosed Anvil,” issued Dec. 5, 2006; U.S. Pat. No. 7,303,108, entitled“Surgical Stapling Instrument Incorporating a Multi-Stroke FiringMechanism with a Flexible Rack,” issued Dec. 4, 2007; U.S. Pat. No.7,367,485, entitled “Surgical Stapling Instrument Incorporating aMultistroke Firing Mechanism Having a Rotary Transmission,” issued May6, 2008; U.S. Pat. No. 7,380,695, entitled “Surgical Stapling InstrumentHaving a Single Lockout Mechanism for Prevention of Firing,” issued Jun.3, 2008; U.S. Pat. No. 7,380,696, entitled “Articulating SurgicalStapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism,”issued Jun. 3, 2008; U.S. Pat. No. 7,404,508, entitled “SurgicalStapling and Cutting Device,” issued Jul. 29, 2008; U.S. Pat. No.7,434,715, entitled “Surgical Stapling Instrument Having MultistrokeFiring with Opening Lockout,” issued Oct. 14, 2008; U.S. Pat. No.7,721,930, entitled “Disposable Cartridge with Adhesive for Use with aStapling Device,” issued May 25, 2010; U.S. Pat. No. 8,408,439, entitled“Surgical Stapling Instrument with An Articulatable End Effector,”issued Apr. 2, 2013; and U.S. Pat. No. 8,453,914, entitled “Motor-DrivenSurgical Cutting Instrument with Electric Actuator Directional ControlAssembly,” issued Jun. 4, 2013. The disclosure of each of theabove-cited U.S. Patents is incorporated by reference herein.

While the surgical staplers referred to above are described as beingused in endoscopic procedures, it should be understood that suchsurgical staplers may also be used in open procedures and/or othernon-endoscopic procedures. By way of example only, a surgical staplermay be inserted through a thoracotomy, and thereby between a patient'sribs, to reach one or more organs in a thoracic surgical procedure thatdoes not use a trocar as a conduit for the stapler. Such procedures mayinclude the use of the stapler to sever and close a vessel leading to alung. For instance, the vessels leading to an organ may be severed andclosed by a stapler before removal of the organ from the thoraciccavity. Of course, surgical staplers may be used in various othersettings and procedures.

Examples of surgical staplers that may be particularly suited or usethrough a thoracotomy are disclosed in U.S. patent application Ser. No.14/810,786, entitled “Surgical Staple Cartridge with Compression Featureat Knife Slot,” filed Jul. 29, 2015; U.S. Patent Pub. No. 2014/0243801,entitled “Surgical Instrument End Effector Articulation Drive withPinion and Opposing Racks,” published Aug. 28, 2014; U.S. Patent Pub.No. 2014/0239041, entitled “Lockout Feature for Movable Cutting Memberof Surgical Instrument,” published Aug. 28, 2014; U.S. Patent Pub. No.2014/0239042, entitled “Integrated Tissue Positioning and Jaw AlignmentFeatures for Surgical Stapler,” published Aug. 28, 2014; U.S. PatentPub. No. 2014/0239036, entitled “Jaw Closure Feature for End Effector ofSurgical Instrument,” published Aug. 28, 2014; U.S. Patent Pub. No.2014/0239040, entitled “Surgical Instrument with Articulation Lockhaving a Detenting Binary Spring,” published Aug. 28, 2014; U.S. PatentPub. No. 2014/0239043, entitled “Distal Tip Features for End Effector ofSurgical Instrument,” published Aug. 28, 2014; U.S. Patent Pub. No.2014/0239037, entitled “Staple Forming Features for Surgical StaplingInstrument,” published Aug. 28, 2014; U.S. Patent Pub. No. 2014/0239038,entitled “Surgical Instrument with Multi-Diameter Shaft,” publishedAugust 28, 2014; and U.S. Patent Pub. No. 2014/0239044, entitled“Installation Features for Surgical Instrument End Effector Cartridge,”published Aug. 28, 2014. The disclosure of each of the above-cited U.S.Patent Applications is incorporated by reference herein.

While various kinds of surgical stapling instruments and associatedcomponents have been made and used, it is believed that no one prior tothe inventor(s) has made or used the invention described in the appendedclaims.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention,and, together with the general description of the invention given above,and the detailed description of the embodiments given below, serve toexplain the principles of the present invention.

FIG. 1 depicts a perspective view of an exemplary articulating surgicalstapling instrument;

FIG. 2 depicts a side elevational view of the instrument of FIG. 1;

FIG. 3 depicts a perspective view of an end effector of the instrumentof FIG. 1, with the end effector in a closed configuration;

FIG. 4 depicts a perspective view of the end effector of FIG. 3, withthe end effector in an open configuration;

FIG. 5 depicts an exploded perspective view of the end effector of FIG.3;

FIG. 6 depicts a cross-sectional end view of the end effector of FIG. 3,taken along line 6-6 of FIG. 4;

FIG. 7A depicts a cross-sectional side view of the end effector of FIG.3, taken along line 7-7 of FIG. 4, with a firing beam in a proximalposition;

FIG. 7B depicts a cross-sectional side view of the end effector of FIG.3, taken along line 7-7 of FIG. 4, with the firing beam in a distalposition;

FIG. 8 depicts a perspective view of the end effector of FIG. 3,positioned at tissue and having been actuated once in the tissue;

FIG. 9 depicts a side elevational view of another exemplary articulatingsurgical stapling instrument;

FIG. 10 depicts a perspective view of an end effector of the instrumentof FIG. 9, with the end effector in an open configuration;

FIG. 11 depicts a top view of a lower jaw of the end effector of FIG.10;

FIG. 12 depicts a bottom view of an upper jaw of the end effector ofFIG. 10;

FIG. 13 depicts an exploded perspective view of the lower jaw of FIG.11;

FIG. 14 depicts a top view of the lower jaw of FIG. 11;

FIG. 15 depicts a perspective view of a wedge sled of the lower jaw ofFIG. 11;

FIG. 16 depicts a perspective view of a staple row driver assembly ofthe lower jaw of FIG. 11;

FIG. 17 depicts a bottom cross-sectional view of the lower jaw of FIG.11, with the staple row driver assembly of FIG. 16 omitted;

FIG. 18 depicts a cross-sectional perspective view of the lower jaw ofFIG. 11, taken along section line 18-18 of FIG. 17;

FIG. 19 depicts a top view of a pair of the staple row driver assembliesof FIG. 16 and the wedge sled of FIG. 15;

FIG. 20A depicts a side cross-sectional view of the wedge sled of FIG.15 at a first longitudinal position, sliding toward the staple rowdriver assembly of FIG. 16, taken generally along a centerline of thelower jaw of FIG. 11;

FIG. 20B depicts a side cross-sectional view of the wedge sled of FIG.15 at a second longitudinal position, directing the staple row driverassembly of FIG. 16 upwardly, taken generally along a centerline of thelower jaw of FIG. 11;

FIG. 20C depicts a side cross-sectional view of the wedge sled of FIG.15 at a third longitudinal position, with the staple row driver assemblyof FIG. 16 in an upper position, taken generally along a centerline ofthe lower jaw of FIG. 11;

FIG. 21 depicts a perspective view of a cross driver assembly of thelower jaw shown in FIG. 11;

FIG. 22 depicts a top view of the cross driver assembly of FIG. 21;

FIG. 23A depicts a side cross-sectional view of the wedge sled of FIG.15 at a first longitudinal position, sliding toward the cross driverassembly of FIG. 21, taken generally along a centerline of the lower jawof FIG. 11;

FIG. 23B depicts a side cross-sectional view of the wedge sled of FIG.15 at a second longitudinal position, directing the cross driverassembly of FIG. 21 upwardly, taken generally along a centerline of thelower jaw of FIG. 11;

FIG. 23C depicts a side cross-sectional view of the wedge sled of FIG.15 at a third longitudinal position, with the cross driver assembly ofFIG. 21 in an upper position, taken generally along a centerline of thelower jaw of FIG. 11;

FIG. 24 depicts a perspective cross-sectional view of the lower jaw ofFIG. 11, with the wedge sled of FIG. 15 at the third longitudinalposition, and with the cross driver assembly of FIG. 21 in the upperposition;

FIG. 25A depicts a schematic representation of a liver having a vesselextending through the liver tissue;

FIG. 25B depicts the schematic representation of the end effector ofFIG. 10 severing the liver tissue of FIG. 25A;

FIG. 25C depicts the schematic representation of the vessel of FIG. 25Bexposed from the severed liver tissue of FIG. 25A;

FIG. 25D depicts the schematic representation of the end effector ofFIG. 10 stapling the exposed vessel of FIG. 25C;

FIG. 25E depicts the schematic representation of the vessel of FIG. 25Dexposed and stapled;

FIG. 25F depicts the schematic representation of the liver of FIG. 25Ahaving a portion of the liver tissue and the vessel resected therefrom;

FIG. 26 depicts a side elevational view of still another exemplaryarticulating surgical stapling instrument;

FIG. 27 depicts a perspective view of an end effector of the instrumentof FIG. 26, with the end effector in an open configuration;

FIG. 28 depicts a top view of a lower jaw of the end effector of FIG.27;

FIG. 29 depicts a bottom view an upper jaw of the end effector of FIG.27;

FIG. 30 depicts an exploded perspective view of the lower jaw of FIG.27;

FIG. 31 depicts a perspective view of a wedge sled of the lower jawshown in FIG. 30;

FIG. 32 depicts a right perspective view of a triple driver assembly ofthe lower jaw of FIG. 27;

FIG. 33 depicts a right perspective view of another triple driverassembly of the lower jaw of FIG. 27;

FIG. 34 depicts a top view of an arrangement triple driver assemblies ofthe lower jaw of FIG. 27;

FIG. 35A depicts a side cross-sectional view of the wedge sled of FIG.31 at a first longitudinal position, sliding toward the triple driverassemblies of FIG. 34, taken generally along a centerline of the lowerjaw of FIG. 30;

FIG. 35B depicts a side cross-sectional view of the wedge sled of FIG.31 at a second longitudinal position, with the triple driver assembliesof FIG. 34 in an upper position, taken generally along a centerline ofthe lower jaw of FIG. 30;

FIG. 36 depicts a perspective view of the lower jaw of FIG. 30, inpartial cross-section taken along section line 36-36 of FIG. 28;

FIG. 37 depicts a bottom view of the end effector of FIG. 27;

FIG. 38 depicts a top view of the end effector of FIG. 27;

FIG. 39A depicts a schematic representation of a liver having a vesselextending through the liver tissue;

FIG. 39B depicts the schematic representation of the end effector ofFIG. 27 severing the liver tissue of FIG. 39A;

FIG. 39C depicts the schematic representation of the vessel of FIG. 39Bexposed from the severed liver tissue of FIG. 39A;

FIG. 39D depicts the schematic representation of the end effector ofFIG. 27 stapling the exposed vessel of FIG. 39C; and

FIG. 39E depicts the schematic representation of the liver tissue ofFIG. 39A having a portion of the liver tissue and the vessel resectedtherefrom.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the invention may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presentinvention, and together with the description serve to explain theprinciples of the invention; it being understood, however, that thisinvention is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples of the invention shouldnot be used to limit the scope of the present invention. Other examples,features, aspects, embodiments, and advantages of the invention willbecome apparent to those skilled in the art from the followingdescription, which is by way of illustration, one of the best modescontemplated for carrying out the invention. As will be realized, theinvention is capable of other different and obvious aspects, all withoutdeparting from the invention. Accordingly, the drawings and descriptionsshould be regarded as illustrative in nature and not restrictive.

I. Exemplary Surgical Stapler

FIG. 1 depicts an exemplary surgical stapling and severing instrument(10) that includes a handle assembly (20), a shaft assembly (30), and anend effector (40). End effector (40) and the distal portion of shaftassembly (30) are sized for insertion, in a nonarticulated state asdepicted in FIG. 1, through a trocar cannula to a surgical site in apatient for performing a surgical procedure. By way of example only,such a trocar may be inserted in a patient's abdomen, between two of thepatient's ribs, or elsewhere. In some settings, instrument (10) is usedwithout a trocar. For instance, end effector (40) and the distal portionof shaft assembly (30) may be inserted directly through a thoracotomy orother type of incision. It should be understood that terms such as“proximal” and “distal” are used herein with reference to a cliniciangripping handle assembly (20) of instrument (10). Thus, end effector(40) is distal with respect to the more proximal handle assembly (20).It will be further appreciated that for convenience and clarity, spatialterms such as “vertical” and “horizontal” are used herein with respectto the drawings. However, surgical instruments are used in manyorientations and positions, and these terms are not intended to belimiting and absolute.

A. Exemplary Handle Assembly and Shaft Assembly

As shown in FIGS. 1-2, handle assembly (20) of the present examplecomprises pistol grip (22), a closure trigger (24), and a firing trigger(26). Each trigger (24, 26) is selectively pivotable toward and awayfrom pistol grip (22) as will be described in greater detail below.Handle assembly (20) further includes an anvil release button (25), afiring beam reverse switch (27), and a removable battery pack (28).These components will also be described in greater detail below. Ofcourse, handle assembly (20) may have a variety of other components,features, and operabilities, in addition to or in lieu of any of thosenoted above. Other suitable configurations for handle assembly (20) willbe apparent to those of ordinary skill in the art in view of theteachings herein.

As shown in FIGS. 1-3, shaft assembly (30) of the present examplecomprises an outer closure tube (32), an articulation section (34), anda closure ring (36), which is further coupled with end effector (40).Closure tube (32) extends along the length of shaft assembly (30).Closure ring (36) is positioned distal to articulation section (34).Closure tube (32) and closure ring (36) are configured to translatelongitudinally relative to handle assembly (20). Longitudinaltranslation of closure tube (32) is communicated to closure ring (36)via articulation section (34). Exemplary features that may be used toprovide longitudinal translation of closure tube (32) and closure ring(36) will be described in greater detail below.

Articulation section (34) is operable to laterally deflect closure ring(36) and end effector (40) laterally away from the longitudinal axis(LA) of shaft assembly (30) at a desired angle (α). End effector (40)may thereby reach behind an organ or approach tissue from a desiredangle or for other reasons. In some versions, articulation section (34)enables deflection of end effector (40) along a single plane. In someother versions, articulation section (34) enables deflection of endeffector along more than one plane. In the present example, articulationis controlled through an articulation control knob (35) which is locatedat the proximal end of shaft assembly (30). Knob (35) is rotatable aboutan axis that is perpendicular to the longitudinal axis (LA) of shaftassembly (30). Closure ring (36) and end effector (40) pivot about anaxis that is perpendicular to the longitudinal axis (LA) of shaftassembly (30) in response to rotation of knob (35). By way of exampleonly, rotation of knob (35) clockwise may cause corresponding clockwisepivoting of closure ring (36) and end effector (40) at articulationsection (34). Articulation section (34) is configured to communicatelongitudinal translation of closure tube (32) to closure ring (36),regardless of whether articulation section (34) is in a straightconfiguration or an articulated configuration.

In some versions, articulation section (34) and/or articulation controlknob (35) are/is constructed and operable in accordance with at leastsome of the teachings of U.S. Pub. No. 2014/0243801, entitled “SurgicalInstrument End Effector Articulation Drive with Pinion and OpposingRacks,” published Aug. 28, 2014, the disclosure of which is incorporatedby reference herein. Articulation section (34) may also be constructedand operable in accordance with at least some of the teachings of U.S.patent application Ser. No. 14/314,125, entitled “Articulation DriveFeatures for Surgical Stapler,” filed Jun. 25, 2014, the disclosure ofwhich is incorporated by reference herein; and/or in accordance with thevarious teachings below. Other suitable forms that articulation section(34) and articulation knob (35) may take will be apparent to those ofordinary skill in the art in view of the teachings herein.

As shown in FIGS. 1-2, shaft assembly (30) of the present examplefurther includes a rotation knob (31). Rotation knob (31) is operable torotate the entire shaft assembly (30) and end effector (40) relative tohandle assembly (20) about the longitudinal axis (LA) of shaft assembly(30). In some versions, rotation knob (31) is operable to selectivelylock the angular position of shaft assembly (30) and end effector (40)relative to handle assembly (20) about the longitudinal axis (LA) ofshaft assembly (30). For instance, rotation knob (31) may betranslatable between a first longitudinal position, in which shaftassembly (30) and end effector (40) are rotatable relative to handleassembly (20) about the longitudinal axis (LA) of shaft assembly (30);and a second longitudinal position, in which shaft assembly (30) and endeffector (40) are not rotatable relative to handle assembly (20) aboutthe longitudinal axis (LA) of shaft assembly (30). Of course, shaftassembly (30) may have a variety of other components, features, andoperabilities, in addition to or in lieu of any of those noted above. Byway of example only, at least part of shaft assembly (30) is constructedin accordance with at least some of the teachings of U.S. Pub. No.2014/0239038, entitled “Surgical Instrument with Multi-Diameter Shaft,”published Aug. 28, 2014, the disclosure of which is incorporated byreference herein. Other suitable configurations for shaft assembly (30)will be apparent to those of ordinary skill in the art in view of theteachings herein.

B. Exemplary End Effector

As also shown in FIGS. 3-5, end effector (40) of the present exampleincludes a lower jaw (50) and a pivotable anvil (60). Anvil (60)includes a pair of integral, outwardly extending pins (66) that aredisposed in corresponding curved slots (54) of lower jaw (50). Anvil(60) is pivotable toward and away from lower jaw (50) between an openposition (shown in FIGS. 2 and 4) and a closed position (shown in FIGS.1, 3, and 7A-7B). Use of the term “pivotable” (and similar terms with“pivot” as a base) should not be read as necessarily requiring pivotalmovement about a fixed axis. For instance, in the present example, anvil(60) pivots about an axis that is defined by pins (66), which slidealong curved slots (54) of lower jaw (50) as anvil (60) moves towardlower jaw (50). In such versions, the pivot axis translates along thepath defined by slots (54) while anvil (60) simultaneously pivots aboutthat axis. In addition or in the alternative, the pivot axis may slidealong slots (54) first, with anvil (60) then pivoting about the pivotaxis after the pivot axis has slid a certain distance along the slots(54). It should be understood that such sliding/translating pivotalmovement is encompassed within terms such as “pivot,” “pivots,”“pivotal,” “pivotable,” “pivoting,” and the like. Of course, someversions may provide pivotal movement of anvil (60) about an axis thatremains fixed and does not translate within a slot or channel, etc.

As best seen in FIG. 5, lower jaw (50) of the present example defines achannel (52) that is configured to receive a staple cartridge (70).Staple cartridge (70) may be inserted into channel (52), end effector(40) may be actuated, and then staple cartridge (70) may be removed andreplaced with another staple cartridge (70). Lower jaw (50) thusreleasably retains staple cartridge (70) in alignment with anvil (60)for actuation of end effector (40). In some versions, lower jaw (50) isconstructed in accordance with at least some of the teachings of U.S.Pub. No. 2014/0239044, entitled “Installation Features for SurgicalInstrument End Effector Cartridge,” published Aug. 28, 2014, thedisclosure of which is incorporated by reference herein. Other suitableforms that lower jaw (50) may take will be apparent to those of ordinaryskill in the art in view of the teachings herein.

As best seen in FIGS. 4-6, staple cartridge (70) of the present examplecomprises a cartridge body (71) and a tray (76) secured to the undersideof cartridge body (71). The upper side of cartridge body (71) presents adeck (73), against which tissue may be compressed when anvil (60) is ina closed position. Cartridge body (71) further defines a longitudinallyextending channel (72) and a plurality of staple pockets (74). A staple(77) is positioned in each staple pocket (74). A staple driver (75) isalso positioned in each staple pocket (74), underneath a correspondingstaple (77), and above tray (76). As will be described in greater detailbelow, staple drivers (75) are operable to translate upwardly in staplepockets (74) to thereby drive staples (77) upwardly through staplepockets (74) and into engagement with anvil (60). Staple drivers (75)are driven upwardly by a wedge sled (78), which is captured betweencartridge body (71) and tray (76), and which translates longitudinallythrough cartridge body (71). Wedge sled (78) includes a pair ofobliquely angled cam surfaces (79), which are configured to engagestaple drivers (75) and thereby drive staple drivers (75) upwardly aswedge sled (78) translates longitudinally through cartridge (70). Forinstance, when wedge sled (78) is in a proximal position as shown inFIG. 7A, staple drivers (75) are in downward positions and staples (77)are located in staple pockets (74). As wedge sled (78) is driven to thedistal position shown in FIG. 7B by a translating knife member (80),wedge sled (78) drives staple drivers (75) upwardly, thereby drivingstaples (77) out of staple pockets (74) and into staple forming pockets(64). Thus, staple drivers (75) translate along a vertical dimension aswedge sled (78) translates along a horizontal dimension.

It should be understood that the configuration of staple cartridge (70)may be varied in numerous ways. For instance, staple cartridge (70) ofthe present example includes two longitudinally extending rows of staplepockets (74) on one side of channel (72); and another set of twolongitudinally extending rows of staple pockets (74) on the other sideof channel (72). However, in some other versions, staple cartridge (70)includes three, one, or some other number of staple pockets (74) on eachside of channel (72). In some versions, staple cartridge (70) isconstructed and operable in accordance with at least some of theteachings of U.S. Pub. No. 2014/0239042, entitled “Integrated TissuePositioning and Jaw Alignment Features for Surgical Stapler,” publishedAug. 28, 2014, the disclosure of which is incorporated by referenceherein. In addition or in the alternative, staple cartridge (70) may beconstructed and operable in accordance with at least some of theteachings of U.S. Pub. No. 2014/0239044, entitled “Installation Featuresfor Surgical Instrument End Effector Cartridge,” published Aug. 28,2014, the disclosure of which is incorporated by reference herein. Othersuitable forms that staple cartridge (70) may take will be apparent tothose of ordinary skill in the art in view of the teachings herein.

As best seen in FIG. 4, anvil (60) of the present example comprises alongitudinally extending channel (62) and a plurality of staple formingpockets (64). Channel (62) is configured to align with channel (72) ofstaple cartridge (70) when anvil (60) is in a closed position. Eachstaple forming pocket (64) is positioned to lie over a correspondingstaple pocket (74) of staple cartridge (70) when anvil (60) is in aclosed position. Staple forming pockets (64) are configured to deformthe legs of staples (77) when staples (77) are driven through tissue andinto anvil (60). In particular, staple forming pockets (64) areconfigured to bend the legs of staples (77) to secure the formed staples(77) in the tissue. Anvil (60) may be constructed in accordance with atleast some of the teachings of U.S. Pub. No. 2014/0239042, entitled“Integrated Tissue Positioning and Jaw Alignment Features for SurgicalStapler,” published Aug. 28, 2014; at least some of the teachings ofU.S. Pub. No. 2014/0239036, entitled “Jaw Closure Feature for EndEffector of Surgical Instrument,” published Aug. 28, 2014; and/or atleast some of the teachings of U.S. Pub. No. 2014/0239037, entitled“Staple Forming Features for Surgical Stapling Instrument,” publishedAug. 28, 2014, the disclosure of which is incorporated by referenceherein. Other suitable forms that anvil (60) may take will be apparentto those of ordinary skill in the art in view of the teachings herein.

In the present example, knife member (80) is configured to translatethrough end effector (40). As best seen in FIGS. 5 and 7A-7B, knifemember (80) is secured to the distal end of a firing beam (82), whichextends through a portion of shaft assembly (30). As best seen in FIGS.4 and 6, knife member (80) is positioned in channels (62, 72) of anvil(60) and staple cartridge (70). Knife member (80) includes a distallypresented cutting edge (84) that is configured to sever tissue that iscompressed between anvil (60) and deck (73) of staple cartridge (70) asknife member (80) translates distally through end effector (40). Asnoted above and as shown in FIGS. 7A-7B, knife member (80) also driveswedge sled (78) distally as knife member (80) translates distallythrough end effector (40), thereby driving staples (77) through tissueand against anvil (60) into formation. Various features that may be usedto drive knife member (80) distally through end effector (40) will bedescribed in greater detail below.

In some versions, end effector (40) includes lockout features that areconfigured to prevent knife member (80) from advancing distally throughend effector (40) when a staple cartridge (70) is not inserted in lowerjaw (50). In addition or in the alternative, end effector (40) mayinclude lockout features that are configured to prevent knife member(80) from advancing distally through end effector (40) when a staplecartridge (70) that has already been actuated once (e.g., with allstaples (77) deployed therefrom) is inserted in lower jaw (50). By wayof example only, such lockout features may be configured in accordancewith at least some of the teachings of U.S. Pub. No. 2014/0239041,entitled “Lockout Feature for Movable Cutting Member of SurgicalInstrument,” published Aug. 28, 2014, the disclosure of which isincorporated by reference herein; and/or at least some of the teachingsof U.S. patent application Ser. No. 14/314,108, entitled “Method ofUsing Lockout Features for Surgical Staple cartridge,” filed on Jun. 25,2014, the disclosure of which is incorporated by reference herein. Othersuitable forms that lockout features may take will be apparent to thoseof ordinary skill in the art in view of the teachings herein.Alternatively, end effector (40) may simply omit such lockout features.

C. Exemplary Actuation of Anvil

In the present example, anvil (60) is driven toward lower jaw (50) byadvancing closure ring (36) distally relative to end effector (40).Closure ring (36) cooperates with anvil (60) through a camming action todrive anvil (60) toward lower jaw (50) in response to distal translationof closure ring (36) relative to end effector (40). Similarly, closurering (36) may cooperate with anvil (60) to open anvil (60) away fromlower jaw (50) in response to proximal translation of closure ring (36)relative to end effector (40). By way of example only, closure ring (36)and anvil (60) may interact in accordance with at least some of theteachings of U.S. Pub. No. 2014/0239036, entitled “Jaw Closure Featurefor End Effector of Surgical Instrument,” published Aug. 28, 2014, thedisclosure of which is incorporated by reference herein; and/or inaccordance with at least some of the teachings of U.S. patentapplication Ser. No. 14/314,108, entitled “Jaw Opening Feature forSurgical Stapler,” filed on Jun. 25, 2014, the disclosure of which isincorporated by reference herein. Exemplary features that may be used toprovide longitudinal translation of closure ring (36) relative to endeffector (40) will be described in greater detail below.

As noted above, handle assembly (20) includes pistol grip (22) andclosure trigger (24). As also noted above, anvil (60) is closed towardlower jaw (50) in response to distal advancement of closure ring (36).In the present example, closure trigger (24) is pivotable toward pistolgrip (22) to drive closure tube (32) and closure ring (36) distally.Various suitable components that may be used to convert pivotal movementof closure trigger (24) toward pistol grip (22) into distal translationof closure tube (32) and closure ring (36) relative to handle assembly(20) will be apparent to those of ordinary skill in the art in view ofthe teachings herein. When closure trigger (24) reaches a fully pivotedstate, such that anvil (60) is in a fully closed position relative tolower jaw (50), locking features in handle assembly (20) lock theposition of closure trigger (24) and closure tube (32), thereby lockinganvil (60) in a fully closed position relative to lower jaw (50). Theselocking features are released by actuation of anvil release button (25).Anvil release button (25) is configured and positioned to be actuated bythe thumb of the operator hand that grasps pistol grip (22). In otherwords, the operator may grasp pistol grip (22) with one hand, actuateclosure trigger (24) with one or more fingers of the same hand, and thenactuate anvil release button (25) with the thumb of the same hand,without ever needing to release the grasp of pistol grip (22) with thesame hand. Other suitable features that may be used to actuate anvil(60) will be apparent to those of ordinary skill in the art in view ofthe teachings herein.

D. Exemplary Actuation of Firing Beam

In the present example, instrument (10) provides motorized control offiring beam (82). In particular, instrument (10) includes motorizedcomponents that are configured to drive firing beam (82) distally inresponse to pivoting of firing trigger (26) toward pistol grip (22). Insome versions, a motor (not shown) is contained in pistol grip (22) andreceives power from battery pack (28). This motor is coupled with atransmission assembly (not shown) that converts rotary motion of a driveshaft of the motor into linear translation of firing beam (82). In somesuch versions, firing beam (82) may only be advanced distally when anvil(60) is in a fully closed position relative to lower jaw (50). Afterfiring beam (82) is advanced distally to sever tissue and drive staples(77) as described above with reference to FIGS. 7A-7B, the driveassembly for firing beam (82) may be automatically reversed to drivefiring beam (82) proximally back to the retracted position (e.g., backfrom the position shown in FIG. 7B to the position shown in FIG. 7A).Alternatively, the operator may actuate firing beam reverse switch (27),which may reverse the drive assembly for firing beam (82) in order toretract firing beam (82) to a proximal position. Handle assembly (20) ofthe present example further includes a bailout feature (21), which isoperable to provide a mechanical bailout allowing the operator tomanually retract firing beam (82) proximally (e.g., in the event ofpower loss while firing beam (82) is in a distal position, etc.).

By way of example only, the features that are operable to providemotorized actuation of firing beam (82) may be configured and operablein accordance with at least some of the teachings of U.S. Pat. No.8,210,411, entitled “Motor-Driven Surgical Instrument,” issued Jul. 3,2012, the disclosure of which is incorporated by reference herein. Asanother merely illustrative example, the features that are operable toprovide motorized actuation of firing beam (82) may be configured andoperable in accordance with at least some of the teachings of U.S. Pat.No. 8,453,914, entitled “Motor-Driven Surgical Cutting Instrument withElectric Actuator Directional Control Assembly,” issued Jun. 4, 2013,the disclosure of which is incorporated by reference herein. As yetanother merely illustrative example, the features that are operable toprovide motorized actuation of firing beam (82) may be configured andoperable in accordance with at least some of the teachings of U.S.patent application Ser. No. 14/226,142, entitled “Surgical InstrumentComprising a Sensor System,” filed Mar. 26, 2014, the disclosure ofwhich is incorporated by reference herein.

Other suitable components, features, and configurations that may be usedto provide motorization of firing beam (82) will be apparent to those ofordinary skill in the art in view of the teachings herein. It shouldalso be understood that some other versions may provide manual drivingof firing beam (82), such that a motor may be omitted. By way of exampleonly, firing beam (82) may be manually actuated in accordance with atleast some of the teachings of any other reference cited herein.

FIG. 8 shows end effector (40) having been actuated through a singlestroke through tissue (90). As shown, cutting edge (84) (obscured inFIG. 8) has cut through tissue (90), while staple drivers (75) havedriven two alternating rows of staples (77) through the tissue (90) oneach side of the cut line produced by cutting edge (84). Staples (77)are all oriented substantially parallel to the cut line in this example,though it should be understood that staples (77) may be positioned atany suitable orientations. In the present example, end effector (40) iswithdrawn from the trocar after the first stroke is complete, the spentstaple cartridge (70) is replaced with a new staple cartridge (70), andend effector (40) is then again inserted through the trocar to reach thestapling site for further cutting and stapling. This process may berepeated until the desired amount of cuts and staples (77) have beenprovided. Anvil (60) may need to be closed to facilitate insertion andwithdrawal through the trocar; and anvil (60) may need to be opened tofacilitate replacement of staple cartridge (70).

It should be understood that cutting edge (84) may cut tissuesubstantially contemporaneously with staples (77) being driven throughtissue during each actuation stroke. In the present example, cuttingedge (84) just slightly lags behind driving of staples (77), such thatstaple (77) is driven through the tissue just before cutting edge (84)passes through the same region of tissue, though it should be understoodthat this order may be reversed or that cutting edge (84) may bedirectly synchronized with adjacent staples. While FIG. 8 shows endeffector (40) being actuated in two layers (92, 94) of tissue (90), itshould be understood that end effector (40) may be actuated through asingle layer of tissue (90) or more than two layers (92, 94) of tissue.It should also be understood that the formation and positioning ofstaples (77) adjacent to the cut line produced by cutting edge (84) maysubstantially seal the tissue at the cut line, thereby reducing orpreventing bleeding and/or leaking of other bodily fluids at the cutline. Furthermore, while FIG. 8 shows end effector (40) being actuatedin two substantially flat, apposed planar layers (92, 94) of tissue, itshould be understood that end effector (40) may also be actuated acrossa tubular structure such as a blood vessel, a section of thegastrointestinal tract, etc. FIG. 8 should therefore not be viewed asdemonstrating any limitation on the contemplated uses for end effector(40). Various suitable settings and procedures in which instrument (10)may be used will be apparent to those of ordinary skill in the art inview of the teachings herein.

It should also be understood that any other components or features ofinstrument (10) may be configured and operable in accordance with any ofthe various references cited herein. Additional exemplary modificationsthat may be provided for instrument (10) will be described in greaterdetail below. Various suitable ways in which the below teachings may beincorporated into instrument (10) will be apparent to those of ordinaryskill in the art. Similarly, various suitable ways in which the belowteachings may be combined with various teachings of the references citedherein will be apparent to those of ordinary skill in the art. It shouldalso be understood that the below teachings are not limited toinstrument (10) or devices taught in the references cited herein. Thebelow teachings may be readily applied to various other kinds ofinstruments, including instruments that would not be classified assurgical staplers. Various other suitable devices and settings in whichthe below teachings may be applied will be apparent to those of ordinaryskill in the art in view of the teachings herein.

II. Exemplary Alternative Stapling End Effector

While the above surgical instrument (10) provides one example of an endeffector (40) that may be used to staple and sever tissue within apatient, it will be appreciated that the human body is comprised a widevariety of tissues located in distinct, sometimes difficult to accessregions throughout the patient. For example, a liver includes tissueincluding vessels or ducts passing throughout. In settings where theliver includes a tumor, it may be desirable to resect the portion of theliver containing the tumor. The resection may be anatomic (e.g.,resection of the right or left side of the liver, inclusive of the lobeson that side) or non-anatomic (e.g., resection of just a single lobe orwedge of liver tissue). This resection process may entail at least threekinds of steps—a first step to dissect the tissue (e.g., liverparenchyma) around the vessels or ducts, to thereby isolate or revealthe vessels or ducts; a second step to ligate those vessels or ducts;and a third step to sever the ligated vessels or ducts. In someinstances, the ligated ver

One such method of liver resection includes the well known Kelly clampmethod, where a Kelly style clamp is used to compress the liver tissueand thereby dissect the tissue through a crushing action. However,treatments may require many instruments to accommodate such a widevariety of tissues and vessels or ducts within the human body, therebyadding to the time and complexity associated with assessing the state ofthe tissue, selecting and/or changing instruments, and performing theresection. It may therefore be desirable to provide a surgicalinstrument (210, 410) with an end effector (212, 412) having a pair ofcrush surfaces (214, 216, 414, 416) that are configured to sever tissueby crushing the tissue; while also providing an adjacent staplecartridge (218, 418) to selectively ligate one or more vessels or ductspassing through the tissue. Thereby, a single surgical instrument (210,410) will allow the operator to more quickly assess the tissue andproceed with further tissue dissection and/or ligation of vessels andducts.

Surrgical instruments (210, 410) are described below in the context ofdissecting liver tissue (e.g., liver parenchyma) with crush surfaces(214, 216, 414, 416) and using staples to ligate associated vessels orducts (e.g., portal vein, hepatic vein branches, hepatic arterybranches, extrahepatic vessels, etc.). In some instances (e.g., in thecase of hepatic vein branches and hepatic artery branches, etc.), thevessel or duct that is sealed by the staples is exposed when theoperator crushes the liver tissue with surfaces (214, 216, 414, 416). Insome other instances (e.g., in the case of the portal vein andextrahepatic vessels, etc.), the vessel or duct that is sealed by thestaples is separate from the liver tissue that the operator has crushedwith surfaces (214, 216, 414, 416). While the following description ofsurgical instruments (210, 410) and method of treatment is provided inthe context of liver resection, it will be appreciated that surgicalinstruments (210, 410) may be alternatively configured to treat anytissue in the human body with similar features. It should also beunderstood that that the features discussed below may be readilyincorporated into surgical instrument (10) discussed above. To this end,like numbers indicate like features described above in greater detail.

In the following examples, end effectors (212, 412) apply at least twolaterally spaced apart rows of staples where the staples in one row havethe same height as the staples in another row. In some variations, endeffectors (212, 412) are modified to apply at least two laterally spacedapart rows of staples where the staples in one row have a height that isdifferent from the height of the staples in another row

A. Exemplary Stapling Instrument with Curved End Effector

FIGS. 9-12 show surgical instrument (210) with end effector (212) havingupper crush surface (214), lower crush surface (216) and staplecartridge (218). Surgical instrument (210) also includes handle assembly(20) and shaft assembly (30) discussed above in greater detail. Exceptas otherwise described below, end effector (212), in conjunction withhandle assembly (20) and shaft assembly (30), is configured and operablesimilar to end effector (40) (see FIG. 1).

End effector (212) of the present example further includes a lower jaw(220) and an upper jaw (222). Upper jaw (222) forms an anvil (224) andis pivotally mounted relative to lower jaw (220) for receiving thetissue therebetween. More particularly, anvil (224) is pivotable towardand away from lower jaw (220) between an open position and a closedposition (e.g., in response to pivotal movement of trigger (24) towardand away from pistol grip (22)). For instance, in the present example,anvil (224) pivots about an axis that is defined by pins (not shown),which slide along curved slots (not shown) of lower jaw (220) as anvil(224) moves toward lower jaw (220). In such versions, the pivot axistranslates along the path defined by slots (not shown) while anvil (224)simultaneously pivots about that axis. In addition or in thealternative, the pivot axis may slide along slots (not shown) first,with anvil (224) then pivoting about the pivot axis after the pivot axisslides a certain distance along the slots (not shown). Alternatively,some versions may provide pivotal movement of anvil (224) about an axisthat remains fixed and does not translate within a slot or channel, etc.

As best seen in FIG. 10 and FIG. 11, lower jaw (220) of the presentexample defines a channel (226) that is configured to receive staplecartridge (218). Staple cartridge (218) may be inserted into channel(226), end effector (212) may be actuated, and then staple cartridge(218) may be removed and replaced with another staple cartridge (218).Lower jaw (220) thus releasably retains staple cartridge (218) inalignment with anvil (224) for actuation of end effector (212). In somealternative versions, the components of staple cartridge (218) are fullyintegrated into lower jaw (220) such that end effector (212) may only beused once. Other suitable forms that lower jaw (220) may take will beapparent to those of ordinary skill in the art in view of the teachingsherein.

End effector (212) is generally shaped for improved access to the tissueduring the surgical procedure. More particularly, end effector (212) hasa linear portion (228) that projects from closure ring (36) and extendsto an arcuate portion (230). Arcuate portion (230) in one example curvestransversely to the right (when viewed from above) relative to thelinear portion (228). However, it will be appreciated that the arcuateportion (230) may alternatively curve transversely to the left (whenviewed from above) relative to the linear portion (228). In any case,lower and upper jaws (220, 222) define the linear and arcuate portions(228, 230) as shown in FIG. 11 and FIG. 12. In addition, lower and upperjaws (220, 222) are tapered such that the end effector narrows in thetransverse dimension toward a distal tip (232) of the end effector (212)for further access within the tissue. As such, a centerline (233) alonga transverse width of end effector (212) extends longitudinally alongend effector (212) following linear and arcuate portions (228, 230)thereof.

Staple cartridge (218) accommodates the shape of lower and upper jaws(220, 222) by further defining the linear and arcuate portions (228,230) and tapering of end effector (212). To this end, staple cartridge(218) of the present example comprises a cartridge body (234) and a tray(236) (see FIG. 18) secured to an underside of cartridge body (234). Anupper side of cartridge body (234) presents a deck (238), against whichtissue may be compressed when anvil (224) is in a closed position. Insome versions, lower crush surface (216) is positioned along staplecartridge (218). However, it will be appreciated that lower crushsurface (216), as well as cooperating upper crush surface (214), may bealternatively positioned along end effector (212) for severing tissuevia compression.

Cartridge body (234) further defines a plurality of staple pockets (242a, 242 b, 242 c) following a predetermined pattern along the centerline(233) of deck (238). More particularly, staple cartridge (218) includestwo longitudinally extending rows of staple pockets (242 a, 242 b, 242c), with a left row on a left side of the centerline (233) and a rightrow and a right side of the centerline (233).

One of a plurality of staples (244 a, 244 b, 244 c) is positioned inrespective staple pockets (242 a, 242 b, 242 c). The left and right rowsof staple pockets (242 a, 242 b, 242 c) are configured to overlap in adirection transverse to the centerline (233) in order to install theplurality of staples (244 a, 244 b, 244 c) within the tissue and inhibitopenings therebetween, for improved ligation. In other words, aconsistent gap (G1) is maintained between adjacent staple pockets (242a, 242 b, 242 c) for consistent overlap in the present example. As usedherein, the term “overlap” is intended to include one featureoverlapping with another in at least one direction. Thus, a feature maybe offset from another feature and still overlap as described herein inthe event that these features overlap in at least one plane, such as atransverse plane including the transverse direction. While exemplarycartridge body (234) includes a variety of staple pockets (242 a, 242 b,242 c) with staples (244 a, 244 b, 244 c) in order to accommodate thearcuate portion (230) as discussed below in additional detail, it shouldbe understood that the configuration of staple cartridge (218) may bevaried in numerous ways. Other suitable forms that staple cartridge(218) may take will be apparent to those of ordinary skill in the art inview of the teachings herein.

As best seen in FIG. 12, anvil (224) of the present example has aplurality of staple forming pockets (246 a, 246 b, 246 c). Each stapleforming pocket (246 a, 246 b, 246 c) is positioned to lie over acorresponding staple pocket (242 a, 242 b, 242c) of staple cartridge(218) when anvil (224) is in a closed position. Staple forming pockets(246 a, 246 b, 246 c) are configured to deform each leg (248) of staples(244 a, 244 b, 244 c) when staples (244 a, 244 b, 244 c) are driventhrough tissue and into anvil (224). In particular, staple formingpockets (246 a, 246 b, 246 c) are configured to bend legs (248) ofstaples (244 a, 244 b, 244 c) to secure the formed staples (244 a, 244b, 244 c) in the tissue. Other suitable forms that anvil (224) may takewill be apparent to those of ordinary skill in the art in view of theteachings herein.

As shown in FIG. 13, staple cartridge (218) includes staple row drivers(252) and a cross staple driver (254) positioned in staple pockets (242a, 242 b, 242 c), underneath corresponding sets of staples (244 a, 244b, 244 c), and above tray (236) (see FIG. 18). As will be described ingreater detail below, staple drivers (252, 254) are operable totranslate upwardly in staple pockets (242 a, 242 b, 242 c) to therebydrive staples (244 a, 244 b, 244 c) upwardly through staple pockets (242a, 242 b, 242 c) and into engagement with anvil (224). Staple drivers(252, 254) are driven upwardly by a distally translating wedge sled(256), which is captured between cartridge body (234) and tray (236)(see FIG. 18), and which translates longitudinally through cartridgebody (234) along a cam slot (257). Wedge sled (256) includes a cam ramp(258) having a leading cam surface (260), an intermediate cam surface(262), and a trailing cam surface (264). By way of example only, leadingcam surface (260) may be angled at approximately 45° relative to ahorizontal plane; and intermediate cam surface (262) may be angled atapproximately 22° relative to a horizontal plane. Alternatively, anyother suitable angles may be used. Cam ramp (258) is generallyconfigured to engage staple drivers (252, 254) and thereby drive stapledrivers (252, 254) upwardly as wedge sled (256) translateslongitudinally through staple cartridge (218) from a proximal sledposition to a distal sled position. For instance, when wedge sled (256)is in the proximal sled position, staple drivers (252, 254) are indownward positions and staples (244 a, 244 b, 244 c) are located instaple pockets (442) below deck (238).

Wedge sled (256) is driven distally by a translating member (266). Byway of example only, translating member (266) may be translated distallyby actuating trigger (26)). Translating member (266) may thus operate ina manner similar to firing beam (82) described above, though translatingmember (266) lacks a cutting edge (84) and is unable to otherwise severtissue. As wedge sled (256) is driven to the distal sled position bytranslating member (266), wedge sled (256) drives staple drivers (252,254) upwardly, thereby driving staples (244 a, 244 b, 244 c) out ofstaple pockets (242 a, 242 b, 242 c) and into staple forming pockets(246 a, 246 b, 246 c). Thus, staple drivers (252, 254) translate alongcorresponding vertical planes as wedge sled (256) translates along ahorizontal plane.

1. Exemplary Upper and Lower Crush Surfaces of End Effector

As shown in FIGS. 12-14, end effector (212) includes upper and lowercrush surfaces (214, 216) extending along linear and arcuate portions(228, 230) thereof, as discussed briefly above. To this end, upper crushsurface (214) is defined by a bottom surface of anvil (224) extendingabout the centerline (233) and surrounding each staple forming pocket(246 a, 246 b, 246 c). Lower crush surface (216) is similarly defined bya top surface of deck (238) extending about the centerline (233) andsurrounding staple pocket (242 a, 242 b, 242 c). In the closed position,lower and upper jaws (220, 222) clamp together with lower crush surface(216) compressed directly against upper crush surface (214) with apredetermined crush pressure therebetween. The predetermined crushpressure is configured to sever a layer of tissue captured betweensurfaces (214, 216), while vessels or ducts within the layer of tissueremain unsevered. As such, the vessels or ducts may be left intact orligated via the staples (244). In the event of ligation, the operatormay remove surgical instrument (210) (see FIG. 2) from the stapledtissue and then cut the vessel or duct using any suitable surgicalinstrument known in the art that is configured to appropriately cut thevessel or duct.

In addition, the narrowing of end effector (212) distally alongcenterline (233) also continuously increases the predetermined crushpressure that may be applied between upper and lower crush surfaces(214, 216) due to the reduction of contact surface area therebetween. Assuch, narrowing of end effector (212) along centerline (233) alsoincreases compression capabilities of end effector (212) in narrowerportions, such as arcuate portion (230), relative to wider portions,such as linear portion (228). In the present example, upper crushsurface (214) is located on anvil (224), and lower crush surface (216)is located on deck (238). However, it will be appreciated that upper andlower crush surfaces (214, 216) may be alternatively locatedrespectively on upper and lower jaws (222, 220) for severing tissue. Assuch, other suitable configurations of upper and lower crush surfaces(214, 216) will be apparent to persons skilled in the art in view of theteachings herein.

2. Exemplary Linear and Arcuate Portions of End Effector

End effector (212) with linear and arcuate portions (228, 230) isconfigured to provide greater access to tissue within the patient duringtreatment. FIG. 13 and FIG. 14 show lower jaw (220) in greater detailhaving four distinct portions extending longitudinally in order alongcenterline (233) from a proximal end portion (270) of lower jaw (220),linear portion (228), arcuate portion (230), to distal tip (232) ofstaple cartridge (218). As such, channel (226) in lower jaw (220) isconfigured to receive staple cartridge (218) and collectively definethese portions (270, 228, 230, 232).

Lower jaw (220) of the present example contains staple cartridge (218)within channel (226) between abutments (272, 274) of staple cartridge(218) and corresponding abutments (276, 278) of lower jaw (220) as shownin FIG. 14. Channel (226) thus effectively cradles staple cartridge(218), where abutments (272, 274) of staple cartridge (218) are capturedby corresponding abutments (276, 278) of lower jaw (220) for securingstaple cartridge (218) in the horizontal plane. Lower jaw (220) andstaple cartridge (218) are also provided with corresponding detents (notshown) to releasably secure staple cartridge (218) in the verticalplane. Because channel (226) receives staple cartridge (218), outerwidths (W1, W2, W3) of lower jaw (222) are defined by the surroundingwalls of lower jaw (222). In contrast, distal tip (232) of staplecartridge (218) protrudes distally beyond lower jaw (222) and thusdefines outer width (W4) of lower jaw (220) in use. However, it will beappreciated that the arrangement between staple cartridge (218) andlower jaw (220) may be varied so that either feature may define theparticular dimensions discussed below. As such, other suitableconfigurations of end effector (212) with widths (W1, W2, W3, W4) willbe apparent to persons skilled in the art in view of the teachingsherein.

Proximal end portion (270) defines proximal width (W1), which isgenerally the widest portion of widths (W1, W2, W3, W4), becauseproximal end portion (270) includes abutments (274, 278) of staplecartridge (218) and lower jaw (222), respectively. From proximal endportion (270), end effector (212) narrows to linear portion (228), whichdefines linear width (W2). In one example, linear width (W2) isgenerally constant along centerline (233) throughout linear portion(228). Linear portion (228) extends distally to arcuate portion (230).

Arcuate portion (230) of the present example tapers down continuouslyfrom linear portions (228) toward distal tip (232) such that the arcuatewidth is variable, but does have average arcuate width (W3), asindicated in FIG. 14. Thus, arcuate portion (230) is curved and taperedfor improved access within the tissue. While the distal end of thearcuate portion (230) is narrower than distal tip (232) in order toaccommodate corresponding abutments (276, 278), distal width (W4) isgenerally narrower than widths (W1, W2, W3), discussed above. Distal tip(232) extends distally from arcuate portion (228) and is generallyrounded such that distal tip (232) may be used for squeezing between andisolating tissues, without necessarily stabbing, cutting, or tearing thetissues in contact with distal tip (232). While many of these abovefeatures have been described specifically with respect to lower jaw(216), it will be appreciated that corresponding proximal end portion(270), linear portion (228), arcuate portion (230), and distal tip (232)are also included with upper jaw (212) (see FIG. 13).

3. Exemplary Arcuate Portion and Overlapping Predetermined StaplePattern of Staple Cartridge

As discussed above, end effector (212) includes arcuate portion (230),along which left and right rows of staple pockets (242 a, 242 b, 242 c)extend through deck (238). Exemplary staple cartridge (218) shown inFIG. 13 and FIG. 14 curves to the right, and, as such, the right row ofstaple pockets (242 a) is positioned radially inwardly from centerline(233), whereas the left row of staple pockets (242 b) is positionedradially outwardly from centerline (233). In addition, staple pockets(242 a) in linear portion (228) and in the right row have a crowndimension (C1) to accommodate staples (244 a). Thus, a consistent gap(G1) is maintained between adjacent staple pockets (242 a) in the row ofthe inner curve, for consistent overlap in the transverse direction withstaple pockets (242 b) in the row of the outer curve.

However, because these staple pockets (242 a, 242 b) follow thecurvature of arcuate portion (230) on each side of centerline (233), theleft or outer row of staple pockets (242 b) defines an elongated arcrelative to the shorter arc, which is defined by the right or inner rowof staple pockets (242 a). Each staple pocket (242 b) and staple (244 b)within arcuate portion (230) of the left or outer row is thus elongatedwith an elongated crown dimension (C2) in order to maintain consistentgap (G1) and overlap with the adjacent staple pockets (242 a) andstaples (244 a). Effectively, a crown (282 b) of each elongated staple(242 b) is longer than a crown (282 a) of each staple (242 a) to accountfor the elongated arc of the left or outer row of staple pockets (242b). Of course, it will be appreciated that other arrangements of staplepockets and associated staples may be used accordingly. For example, oneor more staples may be shortened relative to other staples (244 a) inlinear portion (228) to account for length differences between arcingrows of staple pockets.

Furthermore, while many of these above features have been describedspecifically with respect to lower jaw (216), it will be appreciatedthat corresponding linear portion (228) and arcuate portion (230) arealso included with upper jaw (212) (see FIG. 11). To this end, anvil(224) (see FIG. 11) also includes staple forming pockets (246 a, 246 b)(see FIG. 11) that respectively correspond to staple pockets (242 a, 242b) and include elongated crown dimension (C2) for forming staples (244b) with elongated crown (282 b). Thus, the geometry of upper jaw (212)complements the geometry of lower jaw (216).

4. Exemplary Drivers Along Centerline of Cartridge and Related Methods

FIGS. 15-18 show wedge sled (256) as well as staple row drivers (252)configured to direct staples (244 a, 244 b, 244 c) upwardly toward anvil(224) for forming staples (244 a, 244 b, 244 c). Wedge sled (256)includes spacers (284), projecting from left and right sides thereof,that are configured to center wedge sled (256) in a track slot (286)extending through staple cartridge (218) along centerline (233). Wedgesled (256) includes cam ramp (258) centrally positioned between spacers(284) and projecting upwardly therefrom to align with centerline (244)as wedge sled (256) slides from the proximal sled position to the distalsled position. A rear end portion (288) receives translating member(266), which is configured to translate toward distal tip (232), fordirecting wedge sled (256) distally toward the distal position. Spacers(284) and track slot (286) are configured such that wedge sled (256) mayeffectively slide along centerline (233) throughout arcuate portion(230). In addition, translating member (266) is generally flexible inthe horizontal plane to similarly follow centerline (233) throughoutarcuate portion (230).

A row driver assembly (292) includes a pair of staple row drivers (252)connected by a driver cam (294) extending therebetween. The pair ofstaple row drivers (252) generally includes a distally positioned stapledriver (252) and a proximally positioned staple driver (252) on eachlateral side of driver cam (294). Staple drivers (252) for each rowdriver assembly (292) are generally positioned such that one stapledriver (252) overlaps in the transverse direction with the other stapledriver (252). As such, each row driver assembly (292) is configured tosimilarly overlap another proximally positioned row driver assembly(292) and another distally positioned row driver assembly (292). Eachstaple driver (252) further includes a longitudinal groove (296)configured to cradle crown (282a) of a corresponding one of staples (244a, 244 b). It will be appreciated that each staple driver (252) may beunitarily secured to driver cam (294) relative to the other stapledriver (252) for row driver assembly (292) to accommodate linear andarcuate portions (228, 230) discussed above in greater detail. As such,one of ordinary skill will appreciate the unique configurations ofstaple drivers (252) for sliding vertically through the plurality ofstaple pockets (242 a, 242 b) aligned with staple forming pockets (246a, 246 b) (see FIG. 12) based on the descriptions herein. It will befurther appreciated that the term “assembly” as used herein is notintended to be limited to discrete assembled components. Rather the term“assembly” includes components that may be formed separately andassembled and components that may be formed integrally as a single part.Thus, the term “assembly” is not intended to limit the inventiondescribed herein.

As shown in FIG. 18, cartridge body (234) defines elongated cam slot(257) that receives both cam ramp (258) of wedge sled (256) and drivercam (294) of row driver assembly (292) for engagement therebetween. Camslot (257) extends through cartridge body (234) and along centerline(233) such that each of wedge sled (256) and row driver assembly (292)straddle centerline (233) through central portions thereof, as shown inFIG. 19. In some versions, cam ramp (258) lies centrally alongcenterline (233) such that each of the distal and proximal row staplesdrivers (252) of row driver assembly (292) are on opposing sides ofcenterline (233). Thus, leading, intermediate, and trailing cam surfaces(260, 262, 264) successively engage driver cam (294) to direct eachstaple (244 a, 244 b) upwardly toward anvil (260) for formation.

In use, FIG. 19 shows a top view of a pair of exemplary row driverassemblies (292) overlapped in the transverse direction and straddlingcenterline (233) to represent approximate positions within the pluralityof staple pockets (242 a) as shown in FIG. 20A. In order to drive rowdriver assemblies (292) upwardly toward anvil (224) for forming staples(244 a), translating member (266) forces wedge sled (256) distally toengage driver cam (294). Leading cam surface (260) of cam ramp (258)slides under driver cam (294) and lifts driver cam (294) verticallyupwardly along the relatively steep angle of leading cam surface (260).Given the relatively steep angle of leading cam surface (260), thevertical movement is relatively large in view of the relatively smalldistance that wedge sled (256) slid along through cam slot (257).

As wedge sled (256) continues to translate distally as shown in FIG.20B, intermediate cam surface (262) of cam ramp (258) then slides underdriver cam (294) and lifts driver cam (294) further vertically upwardlyalong the relatively gradual angle of intermediate cam surface (260).The relatively gradual angle of intermediate cam surface (262) lifts rowdriver assembly (292) a relatively small vertical distance in view ofthe relatively large distance that wedge sled (256) slides through camslot (257). Thereby, wedge sled (256) is configured to complete the workto form staple (244 a) within tissue with less force by taking advantageof the known principle that increasing distance over which a force isapplied allows equivalent work to be done with less force.

With staples (244 a) formed on each side of centerline (233) as shown inFIG. 20C, wedge sled (256) continues to slide distally along centerline(233) such that trailing cam surface (264) provides any further upwardforce necessary to inhibit staples (244 a) and/or staple row drivers(252) from recoiling vertically downwardly. In some versions, trailingcam surface (264) is generally horizontal. Wedge sled (256) continues toslide distally toward the distal position along cam slot (257) tofurther drive upward movement of staple row driver assemblies (292)throughout linear and arcuate portions (228, 230) of end effector (212).

5. Exemplary Staple Straddling Centerline in Staple Cartridge

As shown in FIG. 13 and FIG. 21, as wedge sled (256) approaches thedistal position, wedge sled (256) engages a cross driver assembly (300)having a pair of staple row drivers (252) as well as one distallypositioned cross staple driver (254). In the present example, staple rowdrivers (252) may also be referred to as proximal and intermediatestaple row drivers (252), and cross staple driver (254) may also bereferred to as distal cross staple driver (254) given the relativepositions between staple drivers (252, 254), which form cross driverassembly (300). The pair of staple row drivers (252) and cross stapledriver (254) are connected by a driver cam (302) extending therebetween.The pair of staple row drivers (252) generally includes a distallypositioned staple driver (252) and a proximally positioned staple driver(252) on each lateral side of driver cam (302). Staple row drivers (252)for cross driver assembly (300) are generally positioned such that onestaple driver (252) overlaps in the transverse direction with the otherstaple driver (252). As such, cross driver assembly (300) is configuredto similarly overlap a proximally positioned staple row drivers (252).

Cross staple driver (254) extends distally beyond staple row drivers(252) on cross driver assembly (300) and is obliquely angled relative tocenterline (233) such that cross staple driver (254) itself straddlescenterline (233) proximate to distal tip (232) of end effector (212).More particularly, cross staple driver (254) has ends that arepositioned near staple row drivers (252) to maintain consistent gaps(G1) for effective ligation such that staple (244c) is configured tostaple tissue across centerline (233). To this end, each staple driver(252, 254) further includes a longitudinal groove (304) that isconfigured to cradle a corresponding crown (282 a) of staples (244 b,244 c). It will be appreciated that the term “assembly” as used hereinis not intended to be limited to discrete assembled components. Ratherthe term “assembly” includes components that may be formed separatelyand assembled and components that may be formed integrally as a singlepart. Thus, the term “assembly” is not intended to limit the inventiondescribed herein. It will be further appreciated that cross stapledriver (254) is tilted relative to centerline (233) to accommodate thecurvature of arcuate portion (230) and that alternative curvature of anydirections may be similarly accommodated. Thus, the invention describedherein is not intended to be limited to the tilted direction of crossstaple driver (254).

6. Exemplary Shortened Distal End of Staple Cartridge

In order to drive cross driver assembly (300) upwardly toward anvil(224) for forming staples (244 a, 244 b, 244 c), translating member(266) forces wedge sled (256) distally to engage driver cam (302) asshown in FIG. 23A. It should be understood that wedge sled (256) willreach the position shown in FIG. 23A after wedge sled (256) has drivenall of the row driver assemblies (292) to an upper position. As wedgesled (256) translates distally from the position shown in FIG. 23A,leading cam surface (260) of cam ramp (258) slides under driver cam(302) and lifts driver cam (302) vertically upwardly along therelatively steep angle of leading cam surface (260). Given therelatively steep angle of leading cam surface (260), the verticalmovement is relatively large in view of the relatively small distancethat wedge sled (256) slid along through cam slot (257).

As wedge sled (256) continues to translate distally as shown in FIG.23B, intermediate cam surface (262) of cam ramp (258) then slides underdriver cam (302) and lifts driver cam (302) further vertically upwardlyalong the relatively gradual angle of intermediate cam surface (260).The relatively gradual angle of intermediate cam surface (262) lifts rowdriver assembly (292) a relatively small vertical distance in view ofthe relatively large distance that wedge sled (256) slides through camslot (257). Thereby, wedge sled (256) is configured to complete the workto form staples (244 a, 244 b, 244 c) within tissue with less force bytaking advantage of the known principle that increasing distance overwhich a force is applied allows equivalent work to be done with lessforce. In addition, the multiple leading and intermediate cam surfaces(260, 262) allow for cam ramp (258) of wedge sled (256) to have ashortened length along centerline (233), because leading cam surface(260) quickly urges cross driver assembly (300) upwardly, whileintermediate cam surface (262) proves a sufficient vertical force toform staples (244 a, 244 b, 244 c), as discussed above.

With staples (244 a, 244 b) formed on each side of centerline (233) andstaple (244 c) straddling centerline (233) as shown in FIG. 23C and FIG.24, wedge sled (256) continues to slide distally along centerline (233)such that trailing cam surface (264) provides any further upward forcenecessary to inhibit staples (244 a, 244 b, 244 c) and/or row and crossstaple drivers (252, 254) from recoiling vertically downwardly. In someversions, trailing cam surface (264) is generally horizontal.

Wedge sled (256) continues to slide distally until its translationalmovement along centerline (233) is blocked by distal tip (232) of staplecartridge (218). As such, wedge sled (256) effectively parks underneathcross staple driver (254), which in conjunction with tray (236) definesa storage space (306) for wedge sled (256) therebetween. In other words,distal tip (232) inhibits distal movement of wedge sled (256) such thata majority of wedge sled (256) cannot slide distally beyond cross stapledriver (254). Furthermore, a distal portion of cam ramp (258) of wedgesled (256) is received within a lower aperture (308) of distal tip (232)that further defines storage space (306) such that only a minor distalportion of wedge sled (256) slides distally beyond cross staple driver(254), as shown in FIG. 23C and FIG. 24. Moreover, cam surfaces (260,262, 264) do not fully traverse the length of crown (282 a) of thedistal-most staple (244 c)

Cross driver assembly (300), wedge sled (256), and distal tip (232) arethus collectively configured to reduce elongation of distal tip (232) ofend effector (212) for improved access to tissue within patients. First,cross staple driver (254) is cantilevered distally beyond driver cam(302) to increase the distal most position of staple (244 c), whileproviding additional storage space (306) defined underneath. Second,wedge sled (256) includes multiple leading and intermediate cam surfaces(260, 262) to result in the shortened length of cam ramp (258). Third,lower aperture (308) within distal tip (232) provides for finaltranslation along centerline (233) without further distal elongation ofdistal tip (232). Thereby, cross driver assembly (300), wedge sled(256), and distal tip (232) are each configured in part to reduce travelof wedge sled (256) and reduced elongation of distal tip (232) of endeffector (212) for improved access. In addition, the very closelongitudinal positioning of the distal-most staple pocket (242) todistal tip (232) will minimize the occurrence of tissue being severed bycrush surfaces (214, 216) at regions that are distal to the distal-moststaple (244 c).

7. Exemplary Method of Tissue Resection

FIGS. 25A-25F show one example of using end effector (212) to resecttissue, such as a liver parenchyma tissue (310), and to ligate a vesselor duct (316) therein. As noted above, vessel or duct (316) may comprisea hepatic vein or a hepatic artery. It should also be understood thatthe method may further include the use of end effector (212) to ligateother vessels such as the portal vein and extrahepatic vessels, etc.

As shown in FIG. 25B, the operator positions end effector (212) suchthat tissue (310), including vessel or duct (316), is located betweenlower and upper jaws (220, 222). The operator then compresses tissue(310) between upper and lower crush surfaces (214, 216) of upper andlower jaws (220, 222), respectively, to deliver the predetermined crushpressure to tissue (310). By way of example only, jaws (220, 222) may beactuated in this manner by pivoting trigger (24) toward pistol grip(22). It should be understood that jaws (220, 222) need not necessarilybe actuated to a fully closed configuration. In some instances, theoperator may rely on tactile feedback through trigger (24) and pistolgrip (22) to determine whether the operator has achieved a desired gapbetween jaws (220, 222) to suitably crush tissue (310) withoutundesirably damaging vessel or duct (316). In addition or in thealternative, the operator may rely on visual feedback.

In any case, the crush pressure applied by jaws (220, 222) effectivelysevers tissue (310), and the operator then removes end effector (212)from tissue (310) to view whether or not any vessels or ducts (316) arepresent. As shown in FIG. 25C, vessel or duct (316) remains intact andis left exposed, extending between severed portions of tissue (310).

In some instances, the operator may leave vessel or duct (316) intact.However, in the present example, the operator ligates vessel or duct(316) to complete the resection of a severed portion of tissue (310), asshown in FIG. 25D and FIG. 25E. Ligation includes placement of at leastsome of overlapping staples (244 a, 244 b, 244 c) within vessel or duct(316) as discussed above in greater detail. It should therefore beunderstood that the same end effector (212) may be used to crush (andthereby sever) tissue (310) of the liver and also ligate a vessel orduct (316) in the tissue (310). In the present example, after ligationof vessel or duct (316), the operator removes end effector (212) fromliver tissue (310) and severs vessel or duct (316) with another surgicalinstrument (not shown) known in the art for cutting tissue, such as aconventional blade or shears, etc. Thereby, the operator completesresection of a right portion of tissue (310) and the correspondingportion of the vessel or duct (316), as shown in FIG. 25F. The appliedstaples (244 a) seal the severed end (318) of the vessel or duct (316).

As described above, the operator removes end effector (212) for viewingvessel (316) as shown in FIG. 25C. Alternatively, the operator may applythe predetermined crush pressure (or as determined based on tactileand/or visual feedback as noted above), as shown in FIG. 25B, andimmediately thereafter ligate any tissue remaining therein, such asvessel or duct (316). As such, it is not necessary to view such tissue,but the operator may find such viewing desirable in one or more liverresection procedures. It will be appreciated that the above describedresection is merely illustrative and not limited to liver tissue.Alternatively, tissue resection with end effector (212) may be performedon other tissues within the patient as desired by the user.

B. Exemplary Stapling Instrument with Shortened Straight End Effector

FIGS. 26-30 show surgical instrument (410) with end effector (412)having upper crush surface (414), lower crush surface (416), staplecartridge (418), and knife member (419). As noted above, it may bedesirable to provide such a surgical instrument (410) with an endeffector (412) having crush surfaces (414, 416) that are configured tosever tissue by crushing the tissue; while also providing adjacentstaple cartridge (418) to selectively ligate one or more vessels passingthrough the tissue. In addition, knife member (419) is configured to cutthe one or more vessels for complete removal of the surrounding tissue.Thereby, surgical instrument (410) will allow the operator to morequickly assess the tissue and proceed with further tissue severingand/or tissue ligation. Surgical instrument (410) of the present examplealso includes handle assembly (20) and shaft assembly (30) discussedabove in greater detail. Except as otherwise described below, endeffector (412), in conjunction with handle assembly (20) and shaftassembly (30), is configured and operable similar to end effector (40)(see FIG. 1). By way of example only, end effector (412) may have alength of approximately 40 mm and a width of approximately 7 mm.Alternatively, any other suitable dimension may be used.

End effector (412) of the present example includes a lower jaw (420) andan upper jaw (422), which forms an anvil (424). Upper jaw (422) ispivotally mounted relative to lower jaw (420) for receiving the tissuetherebetween. More particularly, anvil (424) is pivotable toward andaway from lower jaw (420) between an open position and a closed position(e.g., in response to pivotal movement of trigger (24) toward and awayfrom pistol grip (22)). For instance, in the present example, anvil(424) pivots about an axis that is defined by pins (not shown), whichslide along curved slots (not shown) of lower jaw (420) as anvil (424)moves toward lower jaw (420). In such versions, the pivot axistranslates along the path defined by slots (not shown) while anvil (424)simultaneously pivots about that axis. In addition or in thealternative, the pivot axis may slide along slots (not shown) first,with anvil (424) then pivoting about the pivot axis after the pivot axisslides a certain distance along the slots (not shown). Alternatively,some versions may provide pivotal movement of anvil (424) about an axisthat remains fixed and does not translate within a slot or channel, etc.

As best seen in FIGS. 28-30, lower jaw (420) of the present exampledefines a channel (426) that is configured to receive staple cartridge(418). Staple cartridge (418) may be inserted into channel (426), endeffector (412) may be actuated, and then staple cartridge (418) may beremoved and replaced with another staple cartridge (418). Lower jaw(420) thus releasably retains staple cartridge (418) in alignment withanvil (424) for actuation of end effector (412). In some alternativeversions, the components of staple cartridge (418) are fully integratedinto lower jaw (420) such that end effector (412) may only be used once.Other suitable forms that lower jaw (420) may take will be apparent tothose of ordinary skill in the art in view of the teachings herein. Inthe present example, lower and upper jaws (420, 422) extend to a distaltip (432), which is further defined by staple cartridge (418).

Staple cartridge (418) of the present example comprises a cartridge body(434) and a tray (436) (see FIG. 36) secured to an underside ofcartridge body (434). An upper side of cartridge body (434) presents adeck (438), against which tissue may be compressed when anvil (424) isin a closed position. In the present example, lower crush surface (416)is positioned along staple cartridge (418). However, it will beappreciated that lower crush surface (416), as well as cooperating uppercrush surface (414) may be alternatively positioned along end effector(412) for severing tissue via compression.

Cartridge body (434) further defines an elongated channel (439)extending through lower jaw (420) and linearly along a centerline (440)of end effector (412). Another elongated channel (441) defined by anvil(424) extends through upper jaw (422) and linearly along centerline(440), as well, for reasons discussed below in greater detail. Aplurality of staple pockets (442) follow a predetermined pattern alongdeck (438) on opposing sides of centerline (440). More particularly,staple cartridge (418) includes two longitudinally extending rows ofstaple pockets (442) on one side of centerline (440); and another set oftwo longitudinally extending rows of staple pockets (442) on the otherside of centerline (440). However, in some other versions, staplecartridge (418) may include three, one, or some other number of staplepockets (442) on each side of centerline (440).

One of a plurality of staples (444) is positioned in respective staplepockets (442).

Adjacent rows of staple pockets (442) are configured to overlap in adirection transverse to the centerline (440) in order to install theplurality of staples (444) within the tissue and inhibit openingstherebetween for improved ligation. In other words, a consistent gap(G1) is maintained between adjacent staple pockets (442) for consistentoverlap in the present example. As used herein, the term “overlap” isintended to include one feature overlapping with another in at least onedirection. Thus, a feature may be offset from another feature and stilloverlap as described herein in the event that these features overlap inat least one plane, such as a transverse plane including the transversedirection. Other suitable forms that staple cartridge (418) may takewill be apparent to those of ordinary skill in the art in view of theteachings herein.

With respect to FIGS. 28-30, anvil (424) of the present example has aplurality of staple forming pockets (446). Each staple forming pocket(446) is positioned to lie over a corresponding staple pocket (442) ofstaple cartridge (418) when anvil (424) is in a closed position. Stapleforming pockets (446) are configured to deform each leg (448) of staples(444) when staples (444) are driven through tissue and into anvil (424).In particular, staple forming pockets (446) are configured to bend legs(448) of staples (444) to secure the formed staples (444) in the tissue.Other suitable forms that anvil (424) may take will be apparent to thoseof ordinary skill in the art in view of the teachings herein.

As best seen in FIG. 30, staple cartridge (418) includes staple drivers(452) positioned in staple pockets (442), underneath a correspondingstaple (444), and above tray (436) (see FIG. 36). As will be describedin greater detail below, staple drivers (452) are operable to translateupwardly in staple pockets (442) to thereby drive staples (444) upwardlythrough staple pockets (442) and into engagement with anvil (424).Staple drivers (452) are driven upwardly by a wedge sled (456), which iscaptured between cartridge body (434) and tray (436) (see FIG. 36), andwhich translates longitudinally through cartridge body (434) along apair of cam slots (457). Wedge sled (456) includes a cam ramp (258)having a leading cam surface (460), an intermediate cam surface (462),and a trailing cam surface (464). By way of example only, leading camsurface (460) may be angled at approximately 45° relative to ahorizontal plane; and intermediate cam surface (462) may be angled atapproximately 22° relative to a horizontal plane. Alternatively, anyother suitable angles may be used. Cam ramps (458) are generallyconfigured to engage staple drivers (452) and thereby drive stapledrivers (452) upwardly as wedge sled (456) translates longitudinallythrough staple cartridge (418) from a proximal sled position to a distalsled position. For instance, when wedge sled (456) is in the proximalsled position, staple drivers (452) are in downward positions andstaples (444) are located in staple pockets (442). As wedge sled (456)is driven to the distal sled position by translating knife member (419),wedge sled (456) drives staple drivers (452) upwardly, thereby drivingstaples (444) out of staple pockets (442) and into staple formingpockets (446). Thus, staple drivers (452) translate along respectivevertical planes as wedge sled (456) translates along a horizontal plane.

In the present example, knife member (419) is configured to translatethrough end effector (412). As best seen in FIG. 30, knife member (419)is secured to a distal end of firing beam (82), which extends through aportion of shaft assembly (30). Knife member (80) is positioned inchannels (439, 441) of staple cartridge (418) and anvil (424),respectively. Knife member (419) includes a distally presented cuttingedge (468) that is configured to sever tissue that is compressed betweenanvil (424) and deck (438) of staple cartridge (418) as knife member(419) translates distally through end effector (412). As noted above,knife member (419) also drives wedge sled (456) distally as knife member(419) translates distally through end effector (412), thereby drivingstaples (444) through tissue and against anvil (424) into formation.

1. Exemplary Triple Driver Assembly of Staple Cartridge

FIGS. 30-33 show wedge sled (456) and staple drivers (452), which areconfigured to direct staples (444) upwardly toward anvil (424) forforming staples (444) as described herein. Wedge sled (456) includesspacers (484) projecting from left and right sides of a central portion(485) thereof to a pair of left and right cam ramps (458). Spacers (484)are configured to center wedge sled (456) in a track slot (486) (seeFIG. 36) extending through staple cartridge (418) along centerline(440). Each cam ramp (458) projects upwardly from each respective spacer(484) to align each cam ramp (458) centrally within parallel linear camslots (457) as wedge sled (456) slides from the proximal sled positionto the distal sled position. A rear end portion (488) receivestranslating knife member (419), which is configured to translate towarddistal tip (432), for directing the wedge sled (456) distally toward thedistal position.

A driver assembly (492) includes three staple drivers (452) connected bya driver cam (494) extending therebetween. As such, driver assembly(492) may also be referred to as triple driver assembly (492) Two of thethree staple drivers (452) generally include a distally positionedstaple driver (452) and a proximally positioned staple driver (452) on acommon lateral side of driver cam (494) such that these staple drivers(452) are generally longitudinally aligned. These staple drivers (452)may also be referred to below more specifically as distal and proximalstaple drivers (452). In addition, the third staple driver (452) may bereferred to as intermediate staple driver (452) and overlaps betweendistal and proximal drivers (452) on an opposing side of driver cam(494).

Each of the distal, intermediate, and proximal staple drivers (452) arein parallel with each other. In addition, each triple driver assembly(452) is configured to similarly overlap with another proximallypositioned triple driver assembly (492) and another distally positionedtriple driver assembly (492), as seen in FIG. 34. In other words, tripledriver assemblies (492) are arranged in an alternative fashion in eachrow, such that one triple driver assembly (492) provides a single stapledriver (452) on a first side of the row and two staple drivers (452) ona second side of the row; then the next triple driver assembly (492)provides a pair of staple drivers (452) on the first side of the row anda single staple driver (452) on the second side of the row; and so on.Triple driver assemblies (452) are thus aligned in alternating,asymmetric orientations in each row.

Each staple driver (452) further includes a longitudinal groove (496)that is configured to cradle the crown of a corresponding one of staples(444). It will be appreciated that each staple driver (452) may besecured to driver cam (494) relative to the other staple drivers (452)for triple driver assembly (492) to accommodate linear or arcuateportions of a variety of end effectors, such as end effector (212) (seeFIG. 10) discussed above in greater detail. As such, one of ordinaryskill will appreciate the unique configurations of staple drivers (452)for sliding vertically through the plurality of staple pockets (442)aligned with staple forming pockets (446) (see FIG. 29) based on thedescriptions herein. It will be further appreciated that the term“assembly” as used herein is not intended to be limited to discreteassembled components. Rather the term “assembly” includes componentsthat may be formed separately and assembled and components that may beformed integrally as a single part. Thus, the term “assembly” is notintended to limit the invention described herein.

As shown in FIGS. 35A-36, cartridge body (434) defines elongated camslots (457) that receive both cam ramp (458) of wedge sled (456) anddriver cams (494) of each triple driver assembly (492) for engagementtherebetween. Cam slots (457) extend through cartridge body (434) onopposing sides of centerline (440) such that wedge sled (456) straddlescenterline (440) through central portion (485) and triple driverassemblies (492) are on each side of centerline (440). However, camramps (458) and driver cams (494) lie centrally along respective camslots (457) such that each of the leading, intermediate, and trailingcam surfaces (460, 462, 464) successively engage driver cams (494) todirect each staple (444) upwardly toward anvil (460) for formation.

While various arrangements of staple drivers (452) are contemplatedherein, triple driver assembly (492) of the present example hasproximal, intermediate, and distal staple drivers (452) positioned suchthat distal staple driver (452) is cantilevered distally from driver cam(492). More particularly, this cantilever arrangement of distal drivercam (492) increases the distal most position of staple (444) cradledtherein to effectively elongate triple driver assembly (492) to provideadditional space for wedge sled (456). As such, staples pockets (442)and staples (444) may be positioned more closely to distal tip (432).

In use, FIG. 34 shows a top view of two pairs of exemplary triple driverassemblies (492) overlapped in the transverse direction and on opposingsides of centerline (430) to represent approximate positions within theplurality of staple pockets (442) as shown in FIG. 35A. In order todrive triple driver assemblies (492) upwardly toward anvil (424) forforming staples (444), translating knife member (419) forces wedge sled(456) distally to engage driver cam (494). Leading cam surface (460) ofcam ramp (458) slides under driver cam (494) and lifts driver cam (494)vertically upwardly along the relatively steep angle of leading camsurface (460). Given the relatively steep angle of leading cam surface(460), the vertical movement is relatively large in view of therelatively small distance that cam ramps (458) slid along through camslots (457).

As knife member (419) drives wedge sled (456) further distally,intermediate cam surfaces (462) of cam ramps (458) then slide underdriver cams (494) and lift driver cams (494) further vertically upwardlyalong the relatively gradual angle of intermediate cam surface (460).The relatively gradual angle of intermediate cam surface (462) liftstriple driver assemblies (492) a relatively small vertical distance inview of the relatively large distance that cam ramps (458) slide throughcam slots (457). Thereby, wedge sled (456) is configured to complete thework to form staple (444) within tissue with less force by takingadvantage of the known principle that increasing distance over which aforce is applied allows equivalent work to be done with less force.

With the staples (444) formed on each side of centerline (440) as shownin FIG. 35B, translating knife member (419) cuts tissue whilesimultaneously directing wedge sled (456) to continue to slide distallyalong centerline (440) such that trailing cam surfaces (464) provide anyfurther upward force necessary to inhibit staples (444) and/or stapledrivers (452) from recoiling vertically downwardly. In some versions,trailing cam surface (464) is generally horizontal. Wedge sled (456)continues to slide distally toward the distal position along track slot(486) and cam slots (457) to further drive upward movement of triplestaple driver assemblies (492) throughout the remaining length of endeffector (412).

2. Exemplary Shortened Distal End of Staple Cartridge

As shown in FIG. 35B and FIG. 36, wedge sled (456) slides distally untilits translational movement along centerline (440) is blocked by distaltip (432) of staple cartridge (418). As such, wedge sled (456)effectively parks underneath terminal staple drivers (452), which inconjunction with tray (436) define a storage space (506) for wedge sled(456) therebetween. In other words, distal tip (432) inhibits distalmovement of wedge sled (456) such that a majority of wedge sled (456)cannot slide distally beyond terminal staple drivers (452). Furthermore,a distal portion of cam ramps (458) of wedge sled (456) are receivedwithin a pair of lower apertures (508) of distal tip (432) that furtherdefines storage space (506), such that only a minor distal portion ofwedge sled (456) slides distally beyond staple drivers (452), as shownin FIG. 35B and FIG. 36. Moreover, cam surfaces (460, 462, 464) do notfully traverse the length of the crown of the distal-most staple (444).

Triple driver assembly (492), wedge sled (456), and distal tip (432) arethus collectively configured to reduce elongation of distal tip (432) ofend effector (412) for improved access to tissue within patients. First,distal staple driver (452) is cantilevered distally beyond driver cam(494) to increase the distal most position of staple (444), whileproviding additional storage space (506) defined underneath. Second,wedge sled (456) includes multiple leading and intermediate cam surfaces(460, 462) to result in the shortened length of cam ramp (458). Third,lower apertures (508) within distal tip (432) provide for finaltranslation along centerline (440) without further distal elongation ofdistal tip (432). Thereby, triple driver assembly (492), wedge sled(456), and distal tip (432) are each configured in part to reduce travelof wedge sled (456) and reduce elongation of distal tip (432) of endeffector (412) for improved access. In addition, the very closelongitudinal positioning of the distal-most staple pockets (446) todistal tip (432) will minimize the occurrence of tissue being severed bycrush surfaces (414, 416) at regions that are distal to the distal-moststaple (444).

3. Exemplary Upper and Lower Staple Usage Indicia of End Effector

As shown in FIG. 30 and FIGS. 37-38, lower and upper jaws (420, 422)have elongated channels (439, 441) extending through anvil (424) andstaple cartridge (434), respectively. As discussed herein in greaterdetail, elongated channel (439) receives translating knife member (419)that is configured to push wedge sled (456) from the proximal positionto the distal position for selectively forming staples (444) in thetissue of the patient. In addition, knife member (419) includes an upperflange (470) and a lower flange (472) that respectively project fromchannels (441, 439). Flanges (470, 472) extend transversely from thevertical plane defined by knife member (419). Upper flange (470) isconfigured to bear downwardly on the top side of upper jaw (422) asknife member (419) translates through end effector (412); and lowerflange (472) is configured to bear upwardly on the bottom side of lowerjaw (420) as knife member (419) translates through end effector (412).Flanges (470, 472) may thus cooperate to enhance compression that isalready being applied by jaws (420, 422) as knife member (419)translates through end effector (412).

Knife member (419) further includes markings (471, 473) that are onand/or near flanges (470, 472). Markings (471, 473) are positioned suchthat markings (471) may be readily viewed by the user. Markings (471,473) are configured to provide the operator with a visual indication ofthe longitudinal position of cutting edge (468), which may furtherindicate the location of the cut line in tissue. In some versions, thelongitudinal position of cutting edge (468) is proximal to thelongitudinal position of the distal edges of flanges (470, 472).Markings (471, 473) may thus provide the operator with enhanced visualfeedback that is more useful than the visual feedback that wouldotherwise be provided through observation of the distal edges of flanges(470, 472) during translation of knife member (419). It should also beunderstood that markings (471, 473) may enable immediate visualizationof the location of knife member (419) within end effector (412) fromeither the top or bottom view during use.

Furthermore, upper and lower jaws (422, 420) also include a plurality ofupper indicia (474) and a plurality of lower indicia (476),respectively. As shown in FIGS. 27 and 38, upper indicia (474) arevisible from the top of end effector (412) and from the sides of endeffector (412). As shown in FIGS. 27 and 37, lower indicia (476) arevisible from the bottom of end effector (412) and from the sides of endeffector (412). Each upper indicia (474) is more particularly configuredto indicate a remaining amount of staples (444) positioned distally fromeach respective upper indicia (474). Similarly, each lower indicia (476)is configured to indicate the remaining amount of staples (444)positioned distally from each respective lower indicia (476). In otherwords, the upper and lower indicia (474, 476) each provide usage indiciaof staples (444). Thereby, upper and/or lower indicia (474, 476) incombination with markings (471, 473) are configured to indicate to theoperator the remaining amount of staples (444) within staple cartridge(418) in real time during use. The operator may thus view the upper andlower usage indicia (474, 476) more effectively from the top or bottomviews and, in turn, more effectively use remaining staples (444) duringtissue resection.

In some versions, upper and lower usage indicia (474, 476) includes acountdown of remaining staples that extends distally, from “35” staples(444) at the proximal end to “0” staples at distal tip (432), inincrements of five. Alternatively, any other suitable indicia configuredto indicate usage may be so used. It will be appreciated that upper andlower usage indicia (474, 476) may also comprise an accumulation of usedstaples (444), such that upper and lower usage indicia (474, 476)indicate the number of staples (444) used rather than the number ofstaples (444) remaining in staple cartridge (418). As such, the term“usage indicia” is intended to be used broadly, rather than limit theinvention to a particular countdown or accumulation of staples (444).

4. Exemplary Method of Tissue Resection

FIGS. 39A-39E show one example of using end effector (412) to resecttissue, such as a liver parenchyma tissue (310), and to ligate a vesselor duct (316) therein. As noted above, vessel or duct (316) may comprisea hepatic vein or a hepatic artery. It should also be understood thatthe method may further include the use of end effector (412) to ligateother vessels such as the portal vein and extrahepatic vessels, etc.

As shown in FIG. 39B, the operator positions end effector (412) suchthat tissue (310), including vessel or duct (316), is located betweenlower and upper jaws (420, 422). The operator then compresses tissue(310) between upper and lower crush surfaces (414, 416) of upper andlower jaws (420, 422), respectively, to deliver the predetermined crushpressure to tissue (310). By way of example only, jaws (420, 422) may beactuated in this manner by pivoting trigger (24) toward pistol grip(22). It should be understood that jaws (420, 422) need not necessarilybe actuated to a fully closed configuration. In some instances, theoperator may rely on tactile feedback through trigger (24) and pistolgrip (22) to determine whether the operator has achieved a desired gapbetween jaws (420, 422) to suitably crush tissue (310) withoutundesirably damaging vessel or duct (316). In addition or in thealternative, the operator may rely on visual feedback.

In any case, the crush pressure applied by jaws (420, 422) effectivelysevers tissue (310), and the operator then removes end effector (412)from tissue (310) to view whether or not any vessels or ducts arepresent. As shown in FIG. 39C, vessel or duct (316) remains intact andis left exposed, extending between severed portions of tissue (310).

In some instances, the operator may leave vessel or duct (316) intact.However, in the present example, the operator ligates vessel or duct(316) to complete the resection of a severed portion of tissue (310), asshown in FIG. 39D. Ligation includes placement of at least some ofoverlapping staples (444) within vessel or duct (316) as discussed abovein greater detail. It should therefore be understood that the same endeffector (412) may be used to crush (and thereby sever) tissue (310) ofthe liver and also ligate a vessel or duct (316) in the tissue (310). Inthe present example, the vessel or duct (316) is stapled and severedsubstantially simultaneously by end effector (412), resulting in theconfiguration shown in FIG. 39E. As shown, the severed end (318) of thevessel or duct (316) is sealed by staples (444). Thereby, the operatorcompletes resection of a right portion of tissue (310) and thecorresponding portion of the vessel or duct (316).

As described above, the operator removes end effector (412) for viewingvessel (316) as shown in FIG. 39C. Alternatively, the operator may applythe predetermined crush pressure (or as determined based on tactileand/or visual feedback as noted above), as shown in FIG. 39B, andimmediately thereafter sever and ligate any tissue remaining therein,such as vessel or duct (316). As such, it is not necessary to view suchtissue, but the operator may find such viewing desirable in one or moreliver resection procedures. It will be appreciated that the abovedescribed resection is merely illustrative and not limited to livertissue. Alternatively, tissue resection with end effector (412) may beperformed on other tissues within the patient as desired by the user.

III. Exemplary Combinations

The following examples relate to various non-exhaustive ways in whichthe teachings herein may be combined or applied. It should be understoodthat the following examples are not intended to restrict the coverage ofany claims that may be presented at any time in this application or insubsequent filings of this application. No disclaimer is intended. Thefollowing examples are being provided for nothing more than merelyillustrative purposes. It is contemplated that the various teachingsherein may be arranged and applied in numerous other ways. It is alsocontemplated that some variations may omit certain features referred toin the below examples. Therefore, none of the aspects or featuresreferred to below should be deemed critical unless otherwise explicitlyindicated as such at a later date by the inventors or by a successor ininterest to the inventors. If any claims are presented in thisapplication or in subsequent filings related to this application thatinclude additional features beyond those referred to below, thoseadditional features shall not be presumed to have been added for anyreason relating to patentability.

EXAMPLE 1

A method of operating on tissue, comprising: (a) positioning tissuebetween a first jaw and a second jaw of an end effector, wherein thefirst jaw comprises a plurality of staples, wherein the second jawcomprises a plurality of staple forming features, wherein the endeffector is in an open configuration during the act of positioningtissue between the first jaw and the second jaw; (b) compressing thetissue between the first jaw and the second jaw, wherein the act ofcompressing the tissue provides dissection of at least some of thecompressed tissue, wherein the dissected tissue reveals a vessel orduct; and (c) actuating the end effector to drive one or more of thestaples through the revealed vessel or duct, thereby ligating therevealed vessel or duct.

EXAMPLE 2

The method of Example 1, further comprising severing the ligated vesselor duct.

EXAMPLE 3

The method of Example 2, wherein the act of severing the ligated vesselcomprises actuating a cutting member through the end effector.

EXAMPLE 4

The method of Example 3, wherein the act of actuating the actuating theend effector to drive one or more of the staples comprises driving a camdistally with the cutting member, wherein the cam drives the staplestoward the second jaw.

EXAMPLE 5

The method of any one or more of Examples 3 through 4, wherein thecutting member comprises an indicator visually indicating a longitudinalposition of the cutting member, wherein the act of severing the ligatedvessel further comprises observing the indicator to determine thelongitudinal position of the cutting member.

EXAMPLE 6

The method of any one or more of Examples 1 through 5, furthercomprising transitioning the end effector to an open configuration afterperforming the act of compressing the tissue and before performing theact of actuating the end effector to drive one or more of the staples.

EXAMPLE 7

The method of any one or more of Examples 1 through 6, wherein thetissue comprises liver tissue.

EXAMPLE 8

The method of any one or more of Examples 1 through 7, wherein at leasta portion of the end effector extends along a curved path.

EXAMPLE 9

The method of any one or more of Examples 1 through 8, wherein the firstjaw comprises two longitudinally extending rows of staples.

EXAMPLE 10

The method of Example 9, wherein at least a portion of each row ofstaples extends along a curved path.

EXAMPLE 11

The method of Example 10, wherein a first portion of each row of staplesextends along a curved path, wherein a second portion of each row ofstaples extends along a straight path.

EXAMPLE 12

The method of any one or more of Examples 1 through 11, wherein the endeffector further comprises a plurality of staple drivers, wherein eachstaple driver of the plurality of staple drivers is operable tosimultaneously drive at least two respective staples of the plurality ofstaples simultaneously toward the second jaw, wherein the act ofactuating the end effector to drive one or more of the staples comprisesdriving the plurality of staple drivers toward the second jaw, therebydriving the plurality of staples toward the second jaw.

EXAMPLE 13

The method of Example 12, wherein each staple driver spans laterallyacross a plane that extends longitudinally along the lateral center ofthe first jaw.

EXAMPLE 14

The method of any one or more of Examples 12 through 13, wherein theplurality of staple drivers further comprises a distal-most stapledriver, wherein the distal-most staple driver is operable to drive threestaples of the plurality of staples simultaneously toward the secondjaw.

EXAMPLE 15

The method of Example 14, wherein a distal-most staple of the threestaples associated with the distal-most staple driver is orientedobliquely relative to the other two staples of the three staplesassociated with the distal-most staple driver.

EXAMPLE 16

The method of any one or more of Examples 1 through 15, wherein thefirst jaw further comprises a staple cartridge containing the pluralityof staples, the method further comprising removing the staple cartridgefrom the second jaw after performing the act of actuating the endeffector to drive one or more of the staples.

EXAMPLE 17

The method of any one or more of Examples 1 through 16, wherein the endeffector comprises a plurality of staple drivers and a wedge sled,wherein each of the staple drivers comprises an underside having a camsurface, wherein the staple drivers are operable to drive the staplestoward the second jaw, wherein the wedge sled comprises a cam surfaceoperable to bear against the cam surface on the underside of each stapledriver and thereby drive the staple drivers toward the second jaw inresponse to distal movement of the wedge sled, wherein the act ofactuating the end effector to drive one or more of the staples comprisesdriving the wedge sled distally, thereby driving the staple driverstoward the second jaw, thereby driving the staples toward the secondjaw.

EXAMPLE 18

The method of Example 17, wherein the plurality of staple driverscomprises a distal-most staple driver, wherein the act of driving thewedge sled distally comprises driving the wedge sled to a distal-mostposition, wherein a portion of the underside of the distal-most stapledriver extends distally past at least a portion of the cam surface ofthe wedge sled.

EXAMPLE 19

A method of operating on tissue, comprising: (a) positioning livertissue between a first jaw and a second jaw of an end effector, whereinthe first jaw comprises a plurality of staples, wherein the second jawcomprises a plurality of staple forming features, wherein the endeffector is in an open configuration during the act of positioning livertissue between the first jaw and the second jaw; (b) compressing theliver tissue between the first jaw and the second jaw, wherein the actof compressing the liver tissue provides dissection of at least some ofthe compressed liver tissue; and (c) actuating the end effector to driveone or more of the staples through a vessel or duct associated with theliver, thereby ligating the vessel or duct.

EXAMPLE 20

A method of operating on tissue, comprising: (a) positioning livertissue between a first jaw and a second jaw of an end effector, whereinthe first jaw comprises a plurality of staples, wherein the second jawcomprises a plurality of staple forming features, wherein the endeffector is in an open configuration during the act of positioning livertissue between the first jaw and the second jaw; (b) compressing theliver tissue between the first jaw and the second jaw, wherein the actof compressing the liver tissue provides dissection of at least some ofthe compressed liver tissue; and (c) actuating the end effector, whereinthe act of actuating the end effector comprises: (i) driving one or moreof the staples through a vessel or duct associated with the liver,thereby ligating the vessel or duct, and (ii) driving a cutting memberthrough the vessel or duct to thereby sever the vessel or duct, whereinthe vessel or duct is severed adjacent to the staples in the vessel orduct.

EXAMPLE 21

A surgical instrument for treating a tissue of a patient, comprising:(a) a shaft assembly; (b) an end effector extending from the shaftassembly along a jaw centerline, the end effector comprising: (i) afirst jaw having an anvil configured to form a plurality of staplespressed against the anvil, and (ii) a second jaw, wherein the first andsecond jaws are configured to transition between an open configurationand a closed configuration; and (c) a staple cartridge received withinthe second jaw, the staple cartridge comprising: (i) a deck facing theanvil, wherein the deck defines a plurality of staple openings, theplurality of staple openings comprising a first row of staple openingsand a second row of staple openings, the first and second rows of stapleopenings defining a first row centerline therebetween, (ii) a pluralityof staples positioned respectively within the plurality of stapleopenings, (iii) a first driver assembly positioned on the first rowcenterline, wherein the first driver is asymmetric about the first rowcenterline and is configured to drive a first portion of the pluralityof staples, and (iv) a second driver assembly positioned on the firstrow centerline, wherein the second driver assembly is asymmetric aboutthe first row centerline and is configured to drive a second portion ofthe plurality of staples; wherein the first and second driver assembliesalternate such that the first and second driver assemblies overlap in adirection transverse to the first row centerline for forming offset andoverlapping staple rows in tissue.

EXAMPLE 22

The surgical instrument of Example 21, wherein the staple cartridgefurther comprises a wedge sled configured to slide proximate to the deckfrom a proximal sled position to a distal sled position such that thewedge sled is configured to progressively engage the first and seconddriver assemblies sliding toward the distal sled position andprogressively force the first and second portions of the plurality ofstaples toward the anvil for formation in the tissue.

EXAMPLE 23

The surgical instrument of Example 22, wherein the wedge sled has afirst cam ramp, wherein the first cam ramp is configured toprogressively engage the first and second driver assemblies.

EXAMPLE 24

The surgical instrument of Example 23, wherein the plurality of stapleopenings include a third row of staple openings and a fourth row ofstaple openings, the third and fourth row of staple openings defining asecond row centerline therebetween, wherein the first and second rowcenterlines are offset from each other and extending along opposingsides of the jaw centerline, wherein the staple cartridge furthercomprises: (i) a third driver assembly positioned on the second rowcenterline, wherein the third driver assembly is asymmetric about thesecond row centerline and is configured to drive a third portion of theplurality of staples, and (ii) a fourth driver assembly positioned onthe row centerline and being asymmetric about the second row centerlineand configured to drive a fourth portion of the plurality of staples;wherein the wedge sled has a second cam ramp, wherein the second camramp is configured to progressively engage the third and fourth driverassemblies.

EXAMPLE 25

The surgical instrument of any one or more of Examples 22 through 24,wherein the wedge sled has a distal nose, wherein the second jaw has ablocker wall distally positioned therein along the centerline, whereinthe blocker wall is configured to receive the wedge sled thereagainstand inhibit movement of the wedge sled distally beyond the distal sledposition, wherein the blocker wall defines a clearance hole configuredto receive the distal nose of the wedge sled in the distal sledposition.

EXAMPLE 26

The surgical instrument of Example 25, wherein the wedge sled has afirst cam ramp configured to engage the first and second driverassemblies, wherein the second driver assembly is a distal-most driverassembly, wherein a majority of the first cam ramp in the distal sledposition is below the distal-most driver assembly.

EXAMPLE 27

The surgical instrument of any one or more of Examples 21 through 26,wherein the first row centerline is offset from the jaw centerline.

EXAMPLE 28

The surgical instrument of Example 27, wherein the first row centerlineis parallel with the jaw centerline.

EXAMPLE 29

The surgical instrument of any one or more of Examples 21 through 28,wherein the first driver assembly has a first distal driver, a firstintermediate driver, and a first proximal driver; wherein the firstdistal driver, the first intermediate driver, and the first proximaldrivers are operatively connected such that the first distal driver andthe first proximal driver are longitudinally aligned and the firstintermediate driver is transversely offset from each of the first distaldriver and the first proximal driver; wherein the first distal driver,the first intermediate driver, and the first proximal driverrespectively receive the first portion of the plurality of staples.

EXAMPLE 30

The surgical instrument of Example 29, wherein the second driverassembly has a second distal driver, a second intermediate driver, and asecond proximal driver; wherein the second distal driver, the secondintermediate driver, and the second proximal drivers are operativelyconnected such that the second distal driver and the second proximaldriver are longitudinally aligned and the second intermediate driver istransversely offset from each of the second distal driver and the secondproximal driver; wherein the second distal driver, the secondintermediate driver, and the second proximal driver respectively receivethe second portion of the plurality of staples.

EXAMPLE 31

The surgical instrument of Example 30, wherein the first and seconddriver assemblies alternate such that first and second intermediatedrivers of the respective first and second driver assemblies arepositioned on opposing sides of the first row centerline.

EXAMPLE 32

The surgical instrument of Example 31, wherein the first distal driverof the first driver assembly overlaps in the direction transverse to thefirst row centerline with the second proximal driver of the seconddriver assembly.

EXAMPLE 33

The surgical instrument of any one or more of Examples 29 through 32,wherein the first distal driver, the first intermediate driver, and thefirst proximal driver are connected by a first driver cam extendingtherebetween.

EXAMPLE 34

The surgical instrument of Example 33, wherein the staple cartridgefurther comprises a wedge sled configured to slide proximate to the deckfrom a proximal sled position to a distal sled position such that thewedge sled is configured to engage the first driver cam thereby forcingthe first distal driver, the first intermediate driver, and the firstproximal driver toward the anvil for forming the first portion of theplurality of staples against the anvil.

EXAMPLE 35

The surgical instrument of any one or more of Examples 21 through 34,wherein the first jaw has a first elongated channel extendingtherethrough and a first plurality of indicia, wherein the second jawhas a second elongated channel extending therethrough and a secondplurality of indicia, the end effector further comprising a knife memberreceived within the first and second channels, wherein the knife memberis configured to slide distally along the first and second channels andengage a wedge sled for forming staples, wherein the knife membercomprises an first indicator in the first channel and a second indicatorin the first channel, and wherein the first and second indicators inconjunction with the first and second plurality of indicia arerespectively configured to indicate a staple usage to an operator.

EXAMPLE 36

A surgical instrument for treating a tissue of a patient, comprising:(a) a shaft assembly; (b) an end effector extending from the shaftassembly along a jaw centerline, the end effector comprising: (i) afirst jaw having an anvil configured to form a plurality of staplespressed against the anvil, and (ii) a second jaw, wherein the first andsecond jaws are configured to transition between an open configurationand a closed configuration; and (c) a staple cartridge received withinthe second jaw, the staple cartridge comprising: (i) a deck facing theanvil, (ii) a plurality of staple openings formed through the deck,wherein at least one of the staple openings obliquely crosses thecenterline, and (iii) a plurality of staples positioned respectivelywithin the plurality of staple openings.

EXAMPLE 37

The surgical instrument of Example 36, wherein the plurality of stapleopenings comprises a first row of staple openings and a second row ofstaple openings, wherein the first and second rows of staple openingsare on respective sides of the centerline.

EXAMPLE 38

The surgical instrument of Example 37, wherein the at least one stapleopening obliquely crossing the centerline extends from the first row ofstaple openings to the second row of staple openings.

EXAMPLE 39

The surgical instrument of Example 38, wherein the at least one stapleopening that obliquely crosses the centerline is a distal-most stapleopening in the deck.

EXAMPLE 40

The surgical instrument of Example 39, wherein the end effector extendsto a distal tip, wherein the distal-most staple opening in the deck isadjacent to the distal tip.

EXAMPLE 41

The surgical instrument of any one or more of Examples 38 through 40,wherein the end effector, the staple cartridge, and the centerlinehaving a straight portion extending to an arcuate portion, and the atleast one staple opening that obliquely crosses the centerline is formedin the arcuate portion of the staple cartridge.

EXAMPLE 42

The surgical instrument of any one or more of Examples 36 through 41,wherein the end effector, the staple cartridge, and the centerline havethe arcuate portion and a straight portion, wherein straight portionextends to the arcuate portion.

EXAMPLE 43

The surgical instrument of Example 42, wherein the plurality of stapleopenings comprises a first row of staple openings and a second row ofstaple openings, wherein the first and second rows of staple openingsare located on respective sides of the centerline and are formed on thedeck in the straight portion.

EXAMPLE 44

The surgical instrument of any one or more of Examples 37 through 43,wherein the first row of staple openings comprises an outer row ofstaple openings, wherein the second row of staple openings comprises aninner row of staple openings, wherein the outer row of staple openingsis positioned radially outwardly from the centerline in the arcuateportion, wherein the inner row of staple openings is positioned radiallyinwardly from the centerline in the arcuate portion.

EXAMPLE 45

The surgical instrument of Example 44, wherein the outer row of stapleopenings defines a plurality of outer gaps between the adjacent stapleopenings of the plurality of staple openings, wherein the inner row ofstaple openings defines a plurality of inner gaps between adjacentstaple openings of the plurality of staple openings, wherein the innergaps and outer gaps have an equivalent length.

EXAMPLE 46

The surgical instrument of any one or more of Examples 36 through 45,wherein the staple cartridge further comprises a wedge sled configuredto slide proximate to the deck from a proximal sled position to a distalsled position, wherein the distal sled position is below the at leastone of the staple opening obliquely crossing the centerline.

EXAMPLE 47

The surgical instrument of Example 46, further comprising a wedge sledhaving a distal nose, wherein the second jaw has a blocker wall distallypositioned therein along the centerline, wherein the blocker wall isconfigured to receive the wedge sled thereagainst and inhibit movementof the wedge sled distally beyond the distal sled position, wherein theblocker wall defines a clearance hole configured to receive the distalnose of the wedge sled in the distal sled position.

EXAMPLE 48

The surgical instrument of Example 12, wherein a majority of the wedgesled in the distal sled position is below the driver assembly.

EXAMPLE 49

The surgical instrument of any one or more of Examples 36 through 48,wherein the first jaw comprises a first crush surface extendinggenerally parallel with the centerline, wherein the first crush surfaceis configured to receive tissue thereagainst, wherein the second jawcomprises a second crush surface extending generally parallel with thecenterline, wherein the second crush surface is configured to receivetissue thereagainst, wherein the first and second crush surfaces areconfigured to compress tissue therebetween with a crush pressureconfigured to sever the tissue along the first and second crushsurfaces.

EXAMPLE 50

The surgical instrument of Example 49, wherein the end effector, thestaple cartridge, and the centerline have a straight portion extendingto an arcuate portion, wherein the first and second crush surfacesextend along the straight and arcuate portions.

EXAMPLE 51

A surgical instrument for treating a tissue of a patient, comprising:(a) a shaft assembly; (b) an end effector extending from the shaftassembly along a jaw centerline, the end effector comprising: (i) afirst jaw having an anvil configured to form a plurality of staplespressed against the anvil, and (ii) a second jaw, wherein the first andsecond jaws are configured to transition between an open configurationand a closed configuration; and (c) a staple cartridge received withinthe second jaw, the staple cartridge comprising: (i) a deck facing theanvil, wherein the deck defines a plurality of staple openings, whereinthe plurality of staples are positioned respectively within theplurality of staple openings, (ii) a first terminal driver assemblypositioned adjacent to a distal tip of the staple cartridge, wherein thefirst terminal driver assembly is configured to receive a first terminalportion of the plurality of staples, the first terminal driver assemblyat least partially defining a storage space therebelow within the secondjaw, and (iii) a wedge sled configured to slide proximate to the deckfrom a proximal sled position to a distal sled position and engage thefirst terminal driver assembly and force the terminal portion of theplurality of staples toward the anvil for formation in tissue, whereinat least a majority of the wedge sled is configured to fit within thestorage space and not slide distally beyond the first terminal driverassembly when the wedge sled is in the distal sled position.

EXAMPLE 52

The surgical instrument of Example 51, wherein the wedge sled furthercomprises a first cam ramp, the first cam ramp being configured toengage the first terminal driver assembly and force the terminal portionof the plurality of staples toward the anvil for formation in thetissue, wherein a majority of the first cam ramp is configured to fitwithin the storage space when the wedge sled is in the distal sledposition.

EXAMPLE 53

The surgical instrument of any one or more of Examples 51 through 52,wherein the wedge sled has a distal nose, wherein the second jaw has ablocker wall distally positioned therein along the centerline, whereinthe blocker wall is configured to receive the wedge sled thereagainstand inhibit movement of the wedge sled distally beyond the distal sledposition.

EXAMPLE 54

The surgical instrument of Example 53, wherein the blocker wall definesa clearance hole configured to receive the distal nose of the wedge sledin the distal sled position.

EXAMPLE 55

The surgical instrument of any one or more of Examples 51 through 54,wherein the wedge sled has a first cam ramp configured to engage thefirst terminal driver assembly, the first cam ramp further comprising:(A) a leading cam surface defining a steep angle slope, and (B) anintermediate cam surface defining a gradual angle slope, the gradualangle slope being angled less than the steep angle slope relative to thedeck, wherein the driver cam is configured to be engaged by the leadingcam surface to lift the driver assembly upward toward the first jaw overa relatively short distance for decreasing an elongation of the wedgesled, and wherein driver cam is further configured to be engaged by theintermediate cam surface to further lift the drive assembly upwardtoward the first jaw over a relatively long distance for providingenough force to compress the first and second staples against the anvilfor use in tissue.

EXAMPLE 56

The surgical instrument of any one or more of Examples 51 through 55,wherein the first terminal driver assembly has a first terminal distaldriver, a first terminal intermediate driver, and a first terminalproximal driver; wherein the first terminal distal driver, the firstterminal intermediate driver, and the first terminal proximal driversare operatively connected such that the first terminal distal driver isdistally cantilevered relative to the first terminal intermediate driverand the first terminal intermediate driver for a maximum elongation ofthe storage space therebelow, wherein the first terminal distal driveris adjacent to the distal tip of the staple cartridge.

EXAMPLE 57

The surgical instrument of Example 56, wherein the first terminal distaldriver, the first terminal intermediate driver, and the first terminalproximal driver are operatively connected such that the first terminaldistal driver and the first terminal proximal driver are longitudinallyaligned and the first terminal intermediate driver is transverselyoffset from each of the first terminal distal driver and the firstterminal proximal driver, wherein the first terminal distal driver, thefirst terminal intermediate driver, and the first terminal proximaldriver respectively receive the first terminal portion of the pluralityof staples.

EXAMPLE 58

The surgical instrument of any one or more of Examples 51 through 57,wherein the staple cartridge further comprises a second terminal driverassembly positioned adjacent to the distal tip and configured to receivea second terminal portion of the plurality of staples, the secondterminal driver assembly further defining the storage space therebelowwithin second jaw.

EXAMPLE 59

The surgical instrument of Example 58, wherein the second terminaldriver assembly comprises a second terminal distal driver, a secondterminal intermediate driver, and a second terminal proximal driver;wherein the second terminal distal driver, the second terminalintermediate driver, and the second terminal proximal drivers areoperatively connected such that the second terminal distal driver isdistally cantilevered relative to the second terminal intermediatedriver and the second terminal intermediate driver for a maximumelongation of the storage space therebelow, wherein the second terminaldistal driver is adjacent to the distal tip.

EXAMPLE 60

The surgical instrument of Example 59,wherein the first and secondterminal distal driver assemblies are positioned on opposing sides ofthe centerline.

EXAMPLE 61

The surgical instrument of Example 60, wherein the first and secondterminal distal driver assemblies are positioned such that the secondterminal distal driver assembly mirrors the first terminal distal driverassembly about the centerline.

EXAMPLE 62

The surgical instrument of any one or more of Examples 60 through 61,wherein the wedge sled has a first cam ramp and a second cam ramp,wherein the first cam ramp is configured to engage the first terminaldistal driver assembly, wherein the second cam ramp is configured toengage the second terminal distal driver assembly.

EXAMPLE 63

The surgical instrument of Example 62, wherein the first cam ramp has afirst distal nose, wherein the second cam ramp has a second distal nose,wherein the second jaw has a second jaw having a blocker wall distallypositioned therein along the centerline, wherein the blocker wall isconfigured to receive the wedge sled thereagainst and inhibit movementof the wedge sled distally beyond the distal sled position, wherein theblocker wall defines at least one clearance hole configured to receivethe first and second distal noses of the wedge sled in the distal sledposition.

EXAMPLE 64

The surgical instrument of any one or more of Examples 51 through 63,wherein the first jaw has a first elongated channel extendingtherethrough and a first plurality of indicia, wherein the second jawhas a second elongated channel extending therethrough and a secondplurality of indicia, the instrument further comprising a knife memberreceived within the first and second channels, wherien the knife memberis configured to slide distally the first and second channels and engagethe wedge sled for forming staples, wherein the knife member comprises afirst indicator in the first channel and a second indicator in thesecond channel, and wherein the first and second indicators inconjunction with the first and second plurality of indicia arerespectively configured to indicate a staple usage to an operator.

EXAMPLE 65

A surgical instrument for treating a tissue of a patient, comprising:(a) a shaft assembly; (b) an end effector extending from the shaftassembly along a jaw centerline, the end effector comprising: (i) afirst jaw having an anvil configured to form a plurality of staplespressed against the anvil, and (ii) a second jaw, wherein the first andsecond jaws are configured to transition between an open configurationand a closed configuration; and (c) a staple cartridge received withinthe second jaw, wherein the staple cartridge and the end effector havean arcuate portion, the staple cartridge comprising: (i) a deck facingthe anvil, wherein the deck defines a plurality of staple openings,wherein the plurality of staple openings comprises an outer row ofstaple openings positioned radially outward from the centerline in thearcuate portion and an inner row of staple openings positioned radiallyinward from the centerline in the arcuate portion, and (ii) a pluralityof staples positioned respectively within the plurality of stapleopenings, wherein the plurality of staples include an outer set ofstaples and an inner set of staples for respective receipt within theouter and inner rows of staple openings, wherein at least one staple ofthe outer set of staples has an elongated crown relative to the innerset of staples such that the outer set of staples are configured tooverlap with the inner set of staples in a direction transverse to thecenterline.

EXAMPLE 66

The surgical instrument of Example 65, wherein the end effector, thestaple cartridge, and the centerline have a straight portion, whereinthe straight portion extends to the arcuate portion.

EXAMPLE 67

The surgical instrument of Example 66, wherein the plurality of stapleopenings comprises a first row of staple openings and a second row ofstaple openings, wherein the first and second rows of staple openingsare positioned on respective sides of centerline and are formed on thedeck in the straight portion.

EXAMPLE 68

The surgical instrument of any one or more of Examples 65 through 67,wherein the outer row of staple openings defines a plurality of outergaps between the plurality of staple openings, wherein the inner row ofstaple openings defines a plurality of inner gaps between the pluralityof staple openings, wherein the inner gaps and outer gaps have anequivalent elongation.

EXAMPLE 69

The surgical instrument of any one or more of Examples 65 through 68,wherein the plurality of staple openings further include at least onestaple opening extending between the outer and inner rows of stapleopenings, wherein the at least one staple opening extending between theouter and inner rows of staple opening straddles the centerline.

EXAMPLE 70

The surgical instrument of Example 69, wherein the at least one stapleopening that straddles the centerline is a distal-most staple opening inthe deck.

EXAMPLE 71

The surgical instrument of any one or more of Examples 65 through 70,wherein the first jaw comprises a first crush surface extendinggenerally parallel with the centerline, wherein the first crush surfaceis configured to receive tissue thereagainst, wherein the second jawcomprises a second crush surface extending generally parallel with thecenterline, wherein the second crush surface is configured to receivethe tissue thereagainst, wherein the first and second crush surfaces areconfigured to compress tissue therebetween with a crush pressureconfigured to sever the tissue along the first and second crushsurfaces.

EXAMPLE 72

The surgical instrument of Example 71, wherein the end effector, thestaple cartridge, and the centerline have a straight portion, whereinthe straight portion extends to the arcuate portion, and wherein thefirst and second crush surfaces extend along the straight and arcuateportions.

EXAMPLE 73

The surgical instrument of Example 72, wherein the second crush surfaceis formed on the deck of the staple cartridge.

EXAMPLE 74

The surgical instrument of any one or more of Examples 65 through 73,wherein the arcuate portion extends to a distal tip of the end effector,and wherein at least a portion of the end effector tapers inwardlytoward the distal tip.

EXAMPLE 75

The surgical instrument of any one or more of Examples 65 through 74,wherein staple cartridge further comprises a wedge sled configured toslide proximate to the deck from a proximal sled position to a distalsled position, and wherein the wherein the distal sled position is inthe arcuate portion of the end effector.

EXAMPLE 76

The surgical instrument of Example 75, wherein the staple cartridgefurther comprises a slot positioned below the deck, wherein the slotextends along the centerline at least partially through the arcuateportion.

EXAMPLE 77

The surgical instrument of Example 76, wherein the staple cartridgefurther comprises a driver assembly having a first driver and a seconddriver, the first driver receiving a first staple of the plurality ofstaples, and the second driver receiving a second staple of theplurality of staples, wherein the driver assembly is configured to beengaged by the wedge sled sliding toward the distal sled position andforced toward the first jaw, thereby forcing the first and secondstaples toward the anvil for formation in tissue.

EXAMPLE 78

The surgical instrument of Example 77, wherein the wedge sled comprisesa cam ramp, the cam ramp being positioned on the centerline within theslot and configured to engage the driver assembly and force the driverassembly toward the first jaw.

EXAMPLE 79

The surgical instrument of Example 78, further comprising a translatingmember engaged with wedge sled and configured to be actuated to drivethe wedge sled from the proximal sled position toward the distal sledposition, wherein translating member and wedge sled are configured tofollow the centerline along the slot through the arcuate portion.

EXAMPLE 80

A surgical instrument for treating a tissue of a patient, comprising:(a) a shaft assembly; (b) an end effector extending from the shaftassembly along a jaw centerline, the end effector comprising: (i) afirst jaw having an anvil configured to form a plurality of staplespressed against the anvil, and (ii) a second jaw, wherein the first andsecond jaws are configured to transition between an open configurationand a closed configuration, wherein the first jaw and the second jawdefine a straight portion of the end effector and an arcuate portion ofthe end effector, the arcuate portion extending distally from thestraight portion such that the arcuate portion of the end effector isconfigured to provide access to tissue within a patient for treatment.

EXAMPLE 81

The surgical instrument of Example 80, wherein the straight portiondefines a proximal transverse width generally perpendicular to thecenterline, wherein the arcuate portion defines a distal transversewidth generally perpendicular centerline, wherein the end effectortapers inwardly from the straight portion toward the arcuate portionsuch that the distal transverse width is narrower than the proximaltransverse width.

EXAMPLE 82

The surgical instrument of Example 81, wherein the distal transversewidth of the arcuate portion tapers inwardly toward the centerlinedistally along the centerline from the straight portion.

EXAMPLE 83

The surgical instrument of Example 82, wherein the end effectorcomprises a distal tip, wherein the arcuate portion tapers inwardlytoward the centerline from the straight portion to the distal tip.

EXAMPLE 84

The surgical instrument of any one or more of Examples 80 through 83,further comprising a staple cartridge received within the second jaw,the staple cartridge comprising: (i) a deck facing the anvil, (ii) aplurality of staple openings formed through the deck, and (iii) aplurality of staple positioned respectively within the plurality ofstaple openings.

EXAMPLE 85

The surgical instrument of Example 84, wherein the plurality of stapleopenings comprises a first row of staple openings and a second row ofstaple openings, wherein the first and second rows of staple openingsare positioned on respective sides of centerline and are formed on thedeck in each of the straight and the arcuate portions.

EXAMPLE 86

The surgical instrument of Example 85, wherein the first row of stapleopenings comprises an outer row of staple openings, wherein the secondrow of staple openings comprises an inner row of staple openings,wherein the outer row of staple openings is positioned radiallyoutwardly from the centerline in the arcuate portion, wherein the innerrow of staple openings is positioned radially inwardly from thecenterline in the arcuate portion.

EXAMPLE 87

The surgical instrument of Example 86, wherein the outer row of stapleopenings defines a plurality of outer gaps between the plurality ofstaple openings, wherein the inner row of staple openings defines aplurality of inner gaps between the plurality of staple openings,wherein the inner gaps and outer gaps have an equivalent elongation.

EXAMPLE 88

The surgical instrument of any one or more of Examples 85 through 87,wherein the plurality of staple openings further comprises at least onestaple opening extending between the first and second rows of stapleopenings, wherein the at least one staple opening straddles thecenterline.

EXAMPLE 89

The surgical instrument of Example 88, wherein the at least one stapleopening that straddles the centerline is a distal-most staple opening inthe deck.

EXAMPLE 90

The surgical instrument of any one or more of Examples 84 through 89,wherein the staple cartridge further comprises a wedge sled configuredto slide proximate to the deck from a proximal sled position to a distalsled position, wherein the proximal sled position is in the straightportion of the end effector, wherein the distal sled position is in thearcuate portion of the end effector.

EXAMPLE 91

The surgical instrument of Example 90, wherein the staple cartridgefurther comprises a slot positioned below the deck, wherein the slotextends along the centerline at least partially through each of thestraight and arcuate portions.

EXAMPLE 92

The surgical instrument of Example 91, wherein the staple cartridgefurther comprises a driver assembly having a first driver and a seconddriver, the first driver receiving a first staple of the plurality ofstaples, the second driver receiving a second staple of the plurality ofstaples, wherein the driver assembly is configured to be engaged by thewedge sled sliding toward the distal sled position and forced toward thefirst jaw, thereby forcing the first and second staples toward the anvilfor formation in the tissue.

EXAMPLE 93

The surgical instrument of Example 92, wherein the wedge sled comprisesa cam ramp, the cam ramp being positioned on the centerline within theslot and configured to engage the driver assembly and force the driverassembly toward the first jaw.

EXAMPLE 94

The surgical instrument of any one or more of Examples 80 through 93,wherein the first jaw comprises a first crush surface extendinggenerally parallel with the centerline, wherein the first crush surfaceis configured to receive tissue thereagainst, wherein the second jawcomprises a second crush surface extending generally parallel with thecenterline, wherein the second crush surface is configured to receivetissue thereagainst, wherein the first and second crush surfaces areconfigured to compress tissue therebetween with a crush pressureconfigured to sever the tissue along the first and second crushsurfaces.

EXAMPLE 95

A surgical instrument for treating a tissue of a patient, comprising:(a) a shaft assembly; and (b) an end effector extending from the shaftassembly along a jaw centerline, the end effector comprising: (i) afirst jaw, wherein the first jaw comprises: (A) an anvil configured toform a plurality of staples pressed thereagainst, (B) an upper elongatedchannel extending therethrough, and (C) a first plurality of indiciapositioned proximate to the first elongated channel, (ii) a second jaw,wherein the first and second jaws are configured to transition betweenan open configuration and a closed configuration, wherein the second jawcomprises: (A) a second elongated channel extending therethrough, and(B) a second plurality of indicia positioned proximate to the secondelongated channel, and (iii) a translating member received within thefirst and second channels, wherein the translating member is configuredto slide distally along the first and second channels and engage thewedge sled for forming staples, wherein the translating member comprisesa first indicator and a second indicator, wherein the first and secondindicators in conjunction with the first and lower plurality of indiciaare respectively configured to indicate one or both of staple usage or acut position to an operator.

EXAMPLE 96

The surgical instrument of Example 95, wherein the indicated stapleusage represents an amount of the plurality of staples remaining in thestaple cartridge.

EXAMPLE 97

The surgical instrument of any one or more of Examples 95 through 96,wherein the plurality of first indicia is in the form of a numericalcountdown extending distally along the first jaw, and wherein theplurality of second indicia is in the form of another numericalcountdown extending distally along the second jaw.

EXAMPLE 98

The surgical instrument of any one or more of Examples 95 through 97,further comprising a staple cartridge received within the second jaw.

EXAMPLE 99

The surgical instrument of any one or more of Examples 95 through 98,wherein the translating member is in the form of a knife memberconfigured to cut the tissue.

EXAMPLE 100

The surgical instrument of any one or more of Examples 95 through 99,wherein the translating member comprises a first flange and a secondflange, wherein the first flange extends through the first elongatedchannel and is engaged with the first jaw, wherein the second flangeextends through the second elongated channel and engages the second jaw.

EXAMPLE 101

The surgical instrument of Example 100, wherein the first indicator ison the first flange, wherein the second indicator is on the secondflange.

EXAMPLE 102

The surgical instrument of any one or more of Examples 95 through 101,wherein the first and second elongated channels extend parallel to thecenterline.

EXAMPLE 103

The surgical instrument of Example 102, wherein the first elongatedchannel extends along the centerline.

EXAMPLE 104

The surgical instrument of Example 103, wherein the second channelextends along the centerline.

EXAMPLE 105

A surgical instrument for treating a tissue of a patient, comprising:(a) a shaft assembly; (b) an end effector extending from the shaftassembly along a jaw centerline, the end effector comprising: (i) afirst jaw having an anvil configured to form a plurality of staplespressed against the anvil, and (ii) a second jaw, wherein the first andsecond jaws are configured to transition between an open configurationand a closed configuration; and (c) a staple cartridge received withinthe second jaw, the staple cartridge comprising: (i) a deck facing theanvil, wherein the deck defines a plurality of staple openings, (ii) aplurality of staples positioned respectively within the plurality ofstaple openings, (iii) a wedge sled configured to slide proximate to thedeck from a proximal sled position to a distal sled position, and (iv) adriver assembly having a first driver and a second driver, the firstdriver receiving a first staple of the plurality of staples, and thesecond driver receiving a second staple of the plurality of staples,wherein the driver assembly is configured to be engaged by the wedgesled sliding toward the distal sled position and thereby be forcedtoward the first jaw, thereby forcing the first and second staplestoward the anvil for formation in the tissue, and wherein the driverassembly is positioned along the centerline.

EXAMPLE 106

The surgical instrument of Example 105, wherein the driver assemblycomprises a driver cam configured to be engaged by the wedge sled,wherein the first and second drivers are connected by the driver camextending therebetween, wherein the driver cam is positioned along thecenterline.

EXAMPLE 107

The surgical instrument of Example 106, wherein the driver cam has afirst side and an opposing second side, wherein the first driver isconnected to the first side of the driver cam, wherein the second driveris connected to the opposing second side of the driver cam, wherein thedriver cam straddles the centerline such that the first and seconddrivers are on opposing sides of the centerline.

EXAMPLE 108

The surgical instrument of any one or more of Examples 105 through 107,wherein the wedge sled is configured to slide proximate to the deck fromthe proximal sled position to the distal sled position along thecenterline.

EXAMPLE 109

The surgical instrument of any one or more of Examples 105 through 108,wherein the wedge sled comprises a cam ramp, the cam ramp beingpositioned on the centerline and configured to engage the driverassembly and force the driver assembly toward the first jaw.

EXAMPLE 110

The surgical instrument of claim 105, wherein the end effector, thestaple cartridge, and the centerline have a straight portion extendingto an arcuate portion, wherein the staple cartridge comprises anotherdriver assembly, wherein the driver assemblies are positionedrespectively in the straight and arcuate portions along the centerline.

EXAMPLE 111

The surgical instrument of any one or more of Examples 105 through 110,wherein at least one of the first and second drivers is positioned alongthe centerline.

EXAMPLE 112

The surgical instrument of any one or more of Examples 105 through 111,wherein the driver assembly further comprises a third driver, whereinthe third driver is positioned along the centerline.

EXAMPLE 113

The surgical instrument of any one or more of Examples 105 through 112,wherein the first jaw comprises a first crush surface extendinggenerally parallel with the centerline, wherein the first crush surfaceis configured to receive tissue thereagainst, wherein the second jawcomprises a second crush surface extending generally parallel with thecenterline, wherein the second crush surface is configured to receivethe tissue thereagainst, wherein the first and second crush surfaces areconfigured to compress the tissue therebetween with a crush pressureconfigured to sever the tissue along the first and second crushsurfaces.

EXAMPLE 114

The surgical instrument of Example 113, wherein the second crush surfaceis formed on the deck of the staple cartridge.

EXAMPLE 115

The surgical instrument of any one or more of Examples 105 through 114,wherein the end effector, the staple cartridge, and the centerline havea straight portion extending to an arcuate portion, wherein the firstand second crush surfaces extend along the straight and arcuateportions.

EXAMPLE 116

The surgical instrument of Example 115, wherein the arcuate portionextends to a distal tip of the end effector, wherein the end effectortapers inwardly toward the distal tip.

EXAMPLE 117

The surgical instrument of any one or more of Examples 105 through 116,wherein the wedge sled has a distal nose, wherein the second jaw has ablocker wall distally positioned therein along the centerline, whereinthe blocker wall is configured to receive the wedge sled thereagainstand inhibit movement of the wedge sled distally beyond the distal sledposition, wherein the blocker wall defines a clearance hole configuredto receive the distal nose of the wedge sled in the distal sledposition.

EXAMPLE 118

The surgical instrument of Example 117, wherein a majority of the wedgesled is configured to be positioned below the driver assembly when thewedge sled is in the distal sled position.

IV. Miscellaneous

It should be understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Theabove-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of the claims.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

Versions of the devices described above may have application inconventional medical treatments and procedures conducted by a medicalprofessional, as well as application in robotic-assisted medicaltreatments and procedures. By way of example only, various teachingsherein may be readily incorporated into a robotic surgical system suchas the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale, Calif.Similarly, those of ordinary skill in the art will recognize thatvarious teachings herein may be readily combined with various teachingsof any of the following: U.S. Pat. No. 5,792,135, entitled “ArticulatedSurgical Instrument For Performing Minimally Invasive Surgery WithEnhanced Dexterity and Sensitivity,” issued Aug. 11, 1998, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.5,817,084, entitled “Remote Center Positioning Device with FlexibleDrive,” issued Oct. 6, 1998, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 5,878,193, entitled “Automated EndoscopeSystem for Optimal Positioning,” issued Mar. 2, 1999, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 6,231,565,entitled “Robotic Arm DLUS for Performing Surgical Tasks,” issued May15, 2001, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool with UltrasoundCauterizing and Cutting Instrument,” issued Aug. 31, 2004, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.6,364,888, entitled “Alignment of Master and Slave in a MinimallyInvasive Surgical Apparatus,” issued Apr. 2, 2002, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 7,524,320,entitled “Mechanical Actuator Interface System for Robotic SurgicalTools,” issued Apr. 28, 2009, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 7,691,098, entitled “Platform Link WristMechanism,” issued Apr. 6, 2010, the disclosure of which is incorporatedby reference herein; U.S. Pat. No. 7,806,891, entitled “Repositioningand Reorientation of Master/Slave Relationship in Minimally InvasiveTelesurgery,” issued Oct. 5, 2010, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2013/0012957, entitled“Automated End Effector Component Reloading System for Use with aRobotic System, published Jan. 10, 2013, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2012/0199630, entitled“Robotically-Controlled Surgical Instrument with Force-FeedbackCapabilities,” published Aug. 9, 2012, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2012/0132450, entitled“Shiftable Drive Interface for Robotically-Controlled Surgical Tool,”published May 31, 2012, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2012/0199633, entitled “SurgicalStapling Instruments with Cam-Driven Staple Deployment Arrangements,”published Aug. 9, 2012, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2012/0199631, entitled“Robotically-Controlled Motorized Surgical End Effector System withRotary Actuated Closure Systems Having Variable Actuation Speeds,”published Aug. 9, 2012, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2012/0199632, entitled“Robotically-Controlled Surgical Instrument with SelectivelyArticulatable End Effector,” published Aug. 9, 2012, the disclosure ofwhich is incorporated by reference herein; U.S. Pub. No. 2012/0203247,entitled “Robotically-Controlled Surgical End Effector System,”published Aug. 9, 2012, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2012/0211546, entitled “Drive Interfacefor Operably Coupling a Manipulatable Surgical Tool to a Robot,”published Aug. 23, 2012; U.S. Pub. No. 2012/0138660, entitled“Robotically-Controlled Cable-Based Surgical End Effectors,” publishedJun. 7, 2012, the disclosure of which is incorporated by referenceherein; and/or U.S. Pub. No. 2012/0205421, entitled“Robotically-Controlled Surgical End Effector System with RotaryActuated Closure Systems,” published Aug. 16, 2012, the disclosure ofwhich is incorporated by reference herein.

Versions of the devices described above may be designed to be disposedof after a single use, or they can be designed to be used multipletimes. Versions may, in either or both cases, be reconditioned for reuseafter at least one use. Reconditioning may include any combination ofthe steps of disassembly of the device, followed by cleaning orreplacement of particular pieces, and subsequent reassembly. Inparticular, some versions of the device may be disassembled, and anynumber of the particular pieces or parts of the device may beselectively replaced or removed in any combination. Upon cleaning and/orreplacement of particular parts, some versions of the device may bereassembled for subsequent use either at a reconditioning facility, orby a operator immediately prior to a procedure. Those skilled in the artwill appreciate that reconditioning of a device may utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a closed and sealed container, such as a plastic orTYVEK bag. The container and device may then be placed in a field ofradiation that can penetrate the container, such as gamma radiation,x-rays, or high-energy electrons. The radiation may kill bacteria on thedevice and in the container. The sterilized device may then be stored inthe sterile container for later use. A device may also be sterilizedusing any other technique known in the art, including but not limited tobeta or gamma radiation, ethylene oxide, or steam.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometries, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

I/We claim:
 1. A method of operating on tissue, comprising: (a)positioning tissue between a first jaw and a second jaw of an endeffector, wherein the first jaw comprises a plurality of staples,wherein the second jaw comprises a plurality of staple forming features,wherein the end effector is in an open configuration during the act ofpositioning tissue between the first jaw and the second jaw; (b)compressing the tissue between the first jaw and the second jaw, whereinthe act of compressing the tissue provides dissection of at least someof the compressed tissue, wherein the dissected tissue reveals a vesselor duct; and (c) actuating the end effector to drive one or more of thestaples through the revealed vessel or duct, thereby ligating therevealed vessel or duct.
 2. The method of claim 1, further comprisingsevering the ligated vessel or duct.
 3. The method of claim 2, whereinthe act of severing the ligated vessel comprises actuating a cuttingmember through the end effector.
 4. The method of claim 3, wherein theact of actuating the actuating the end effector to drive one or more ofthe staples comprises driving a cam distally with the cutting member,wherein the cam drives the staples toward the second jaw.
 5. The methodof claim 3, wherein the cutting member comprises an indicator visuallyindicating a longitudinal position of the cutting member, wherein theact of severing the ligated vessel further comprises observing theindicator to determine the longitudinal position of the cutting member.6. The method of claim 1, further comprising transitioning the endeffector to an open configuration after performing the act ofcompressing the tissue and before performing the act of actuating theend effector to drive one or more of the staples.
 7. The method of claim1, wherein the tissue comprises liver tissue.
 8. The method of claim 1,wherein at least a portion of the end effector extends along a curvedpath.
 9. The method of claim 1, wherein the first jaw comprises twolongitudinally extending rows of staples.
 10. The method of claim 9,wherein at least a portion of each row of staples extends along a curvedpath.
 11. The method of claim 10, wherein a first portion of each row ofstaples extends along a curved path, wherein a second portion of eachrow of staples extends along a straight path.
 12. The method of claim 1,wherein the end effector further comprises a plurality of stapledrivers, wherein each staple driver of the plurality of staple driversis operable to simultaneously drive at least two respective staples ofthe plurality of staples simultaneously toward the second jaw, whereinthe act of actuating the end effector to drive one or more of thestaples comprises driving the plurality of staple drivers toward thesecond jaw, thereby driving the plurality of staples toward the secondjaw.
 13. The method of claim 12, wherein each staple driver spanslaterally across a plane that extends longitudinally along the lateralcenter of the first jaw.
 14. The method of claim 12, wherein theplurality of staple drivers further comprises a distal-most stapledriver, wherein the distal-most staple driver is operable to drive threestaples of the plurality of staples simultaneously toward the secondjaw.
 15. The method of claim 14, wherein a distal-most staple of thethree staples associated with the distal-most staple driver is orientedobliquely relative to the other two staples of the three staplesassociated with the distal-most staple driver.
 16. The method of claim1, wherein the first jaw further comprises a staple cartridge containingthe plurality of staples, the method further comprising removing thestaple cartridge from the second jaw after performing the act ofactuating the end effector to drive one or more of the staples.
 17. Themethod of claim 1, wherein the end effector comprises a plurality ofstaple drivers and a wedge sled, wherein each of the staple driverscomprises an underside having a cam surface, wherein the staple driversare operable to drive the staples toward the second jaw, wherein thewedge sled comprises a cam surface operable to bear against the camsurface on the underside of each staple driver and thereby drive thestaple drivers toward the second jaw in response to distal movement ofthe wedge sled, wherein the act of actuating the end effector to driveone or more of the staples comprises driving the wedge sled distally,thereby driving the staple drivers toward the second jaw, therebydriving the staples toward the second jaw.
 18. The method of claim 17,wherein the plurality of staple drivers comprises a distal-most stapledriver, wherein the act of driving the wedge sled distally comprisesdriving the wedge sled to a distal-most position, wherein a portion ofthe underside of the distal-most staple driver extends distally past atleast a portion of the cam surface of the wedge sled.
 19. A method ofoperating on tissue, comprising: (a) positioning liver tissue between afirst jaw and a second jaw of an end effector, wherein the first jawcomprises a plurality of staples, wherein the second jaw comprises aplurality of staple forming features, wherein the end effector is in anopen configuration during the act of positioning liver tissue betweenthe first jaw and the second jaw; (b) compressing the liver tissuebetween the first jaw and the second jaw, wherein the act of compressingthe liver tissue provides dissection of at least some of the compressedliver tissue; and (c) actuating the end effector to drive one or more ofthe staples through a vessel or duct associated with the liver, therebyligating the vessel or duct.
 20. A method of operating on tissue,comprising: (a) positioning liver tissue between a first jaw and asecond jaw of an end effector, wherein the first jaw comprises aplurality of staples, wherein the second jaw comprises a plurality ofstaple forming features, wherein the end effector is in an openconfiguration during the act of positioning liver tissue between thefirst jaw and the second jaw; (b) compressing the liver tissue betweenthe first jaw and the second jaw, wherein the act of compressing theliver tissue provides dissection of at least some of the compressedliver tissue; and (c) actuating the end effector, wherein the act ofactuating the end effector comprises: (i) driving one or more of thestaples through a vessel or duct associated with the liver, therebyligating the vessel or duct, and (ii) driving a cutting member throughthe vessel or duct to thereby sever the vessel or duct, wherein thevessel or duct is severed adjacent to the staples in the vessel or duct.